MCHB HRSA-23-108 (U7A) State MHI_FINAL.pdf

HRSA-23-108 State MHI i

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Maternal and Child Health Bureau

Division of Healthy Start and Perinatal Services

State Maternal Health Innovation Program

Funding Opportunity Number: HRSA-23-108

Funding Opportunity Type(s): New

Assistance Listings Number: 93.110

Application Due Date: June 2, 2023

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: April 13, 2023

Sarah Meyerholz, MPH

Maternal and Women’s Health Branch

Division of Healthy Start and Perinatal Services

Phone: (301) 443-1702

Email: wellwomancare@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act) mailto:wellwomancare@hrsa.gov

508 COMPLIANCE DISCLAIMER

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

Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 State Maternal Health Innovation Program. The purpose of this program is to reduce maternal mortality and severe maternal morbidity (SMM) by supporting state-led demonstrations focused on improving maternal health and addressing maternal health disparities through quality services, a skilled workforce, enhanced data quality and capacity, and innovative programming. This program also engages public health professionals, providers, payers, and consumers through state-led Maternal Health Task forces. These Task Forces review state-specific maternal health data and then implement evidence-based interventions and innovations that address critical gaps in service delivery.

Funding Opportunity Title: State Maternal Health Innovation

Program

Funding Opportunity Number: HRSA-23-108

Due Date for Applications: June 2, 2023

Anticipated FY 2023 Total Available

Funding:

$23,000,000

Estimated Number and Type of Award(s): Up to 23 cooperative agreements

Estimated Annual Award Amount: Up to $2,000,000 per award (see

Summary of Funding)

Cost Sharing/Match Required: No

Period of Performance: September 30, 2023 through

September 29, 2028 (5 years)

Eligible Applicants: Eligible applicants include any domestic public or private entity, including an

Indian tribe or tribal organization (as those terms are defined at 25 U.S.C.

5304 (formerly cited as 25 U.S.C. 450b)).

See 42 CFR § 51a.3(a). Domestic faith-http://www.hrsa.gov/ based and community-based organizations are also eligible to apply.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Application Guide. Visit

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

Technical Assistance

HRSA has scheduled the following webinar:

April 20, 2023

2:00 – 3:30 p.m. ET

Weblink: https://hrsa-gov.zoomgov.com/j/1605992027?pwd=QVRFeFI3d3I0R3QvRkd4S1BXNm95dz09

Attendees without computer access or computer audio can use the dial-in information below.

Call-In Number: 1-833-568-8864

Meeting ID: 160 599 2027

Passcode: 67415884

The webinar will provide an overview of the NOFO and an opportunity for you to ask questions. HRSA will record the webinar and make it available at:

https://mchb.hrsa.gov/fundingopportunities/default.asp http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1605992027?pwd=QVRFeFI3d3I0R3QvRkd4S1BXNm95dz09 https://hrsa-gov.zoomgov.com/j/1605992027?pwd=QVRFeFI3d3I0R3QvRkd4S1BXNm95dz09 https://mchb.hrsa.gov/fundingopportunities/default.asp

HRSA-23-108 State MHI iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

7. REVIEW AND SELECTION PROCESS

8. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: ADDITIONAL INFORMATION FOR APPLICANTS

APPENDIX B: GLOSSARY OF KEY TERMS

APPENDIX C: PAGE LIMIT WORKSHEET

HRSA-23-108 State MHI 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the FY 2023 State

Maternal Health Innovation (State MHI) program.

The purpose of this program is to reduce maternal mortality and severe maternal morbidity (SMM) 1 by supporting state-led demonstrations focused on improving maternal health and addressing maternal health disparities through quality services, a skilled workforce, enhanced data quality and capacity, and innovative programming.

This program also engages public health professionals, providers, payers, and consumers through state-led Maternal Health Task Forces (MHTF). These Task Forces review state-specific maternal health data and then implement evidence-based interventions and innovations that address critical gaps. FY 2023 funding for this program seeks to provide support to expand to new states focused on improving maternal health. Potential applicants should design submissions to implement innovations to improve health outcomes, develop state-specific plans that will guide maternal health efforts, and enhance measurement of maternal health outcomes.

Program Goal

The goal of the State Maternal Health Innovation Program is to improve maternal health in the United States. This will be achieved by supporting multidisciplinary collaboration;

collecting and analyzing maternal health data; and promoting and executing innovation in maternal health service delivery to advance evidence-informed strategies and achieve a measurable impact.

Program Objectives

The program objectives to be accomplished during the period of performance to support programs goals, are:

• By September 29, 2024, 100 percent of recipients will have developed a draft strategic plan to improve maternal health, including addressing identified health disparities and other gaps and incorporating activities outlined in the State Title V

1 Severe maternal morbidity is defined as the “unintended outcomes of the process of labor and delivery that result in significant short-term or long-term consequences to a woman’s health.” Definition is provided by ACOG Clinical Guidance on Severe Maternal Morbidity accessed via https://www.acog.org/Clinical- Guidance-and- Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and- Review?IsMobileSet=false.

https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false

HRSA-23-108 State MHI 2

Needs Assessment. The Maternal Health Strategic Plan should reflect the most recent maternal health data available.

• By September 29, 2024, 100 percent of recipients will use annual maternal health data to report on and implement culturally and linguistically appropriate and innovative approaches to address identified needs and disparities.

• By September 29, 2024, each recipient is expected to document and report annually on maternal health indicators and outcomes that are disaggregated by maternal race/ethnicity, age, level of education, health insurance coverage, and geographic location (urban/rural), and submit to HRSA in an Annual Report on

Maternal Health in order to evaluate existing disparities.

• By September 29, 2025, each recipient and their established Maternal Health

Task Force will update and finalize the Maternal Health Strategic Plan by increasing the number of actionable recommendations based on state-level maternal health data and submit a final strategic plan to guide the work of the

MHTF and the State MHI Program throughout the remainder of the project period.

• By September 29, 2028, increase the number of innovative approaches for replication and scale-up to improve maternal health.

• By September 29, 2028, award recipients will support and evaluate innovations focused on addressing existing maternal health disparities within their state.

For more details, see Program Requirements and Expectations.

2. Background

Authority

The State Maternal Innovation program is authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), which authorizes awards for special projects of regional and national significance (SPRANS) in maternal and child health. SPRANS projects support HRSA’s Maternal and Child Health Bureau’s (MCHB) mission to improve the health and well-being of America’s mothers, children, and families.

HRSA-23-108 State MHI 3

Maternal Mortality and Severe Maternal Morbidity

Approximately 3.6 million women give birth in the United States each year,2 and despite advances in medical care and investments in improving access to care, rates of maternal mortality and SMM have not improved. In 2020, there were 861 maternal deaths in the U.S., an increase from 754 in 2019, representing a maternal mortality rate of 23.8 per 100,000 live births.3 In addition, thousands of women experience unintended outcomes of labor or delivery resulting in significant short- or long-term consequences to their health. In 2020, more than 30,000 women experienced SMM (not including those who only received a blood transfusion).4 Significant maternal health disparities exist in maternal mortality, SMM, and other adverse outcomes, which vary by race, ethnicity, geography, and select indicators of socio-economic status.5 6

History of the State Maternal Health Innovation Program

HRSA launched the State MHI program on September 30, 2019, through five-year cooperative agreements with nine state recipients. The purpose of this first set of demonstration awards is to assist states in strengthening their capacity to address disparities and improve maternal health, including through prevention and reduction of pregnancy-related mortality and SMM.

The first cohort of nine State MHI award recipients are addressing a wide variety of maternal health challenges, each taking a unique approach to improving maternal health in their state. Across the program, the recipients focus on testing various innovative approaches, collaborating with key stakeholders, and addressing and advancing maternal health equity. Recipients utilize various strategies (care coordination, telehealth, mobile care delivery, provider trainings, etc.) and focus activities on a variety of topics (postpartum warning signs, maternal health data, mental health, substance use disorders, etc.). The existing recipients are currently in the fourth year of the period of performance, and will continue with testing and evaluating innovative activities, enhancing maternal health data systems, and supporting the

2 Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2021.

National Vital Statistics Reports; vol 72, no 1. Hyattsville, MD: National Center for Health Statistics. 2023.

DOI: https://dx.doi. org/10.15620/cdc:122047 3 Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022.

DOI: https://dx.doi.org/10.15620/cdc:113967 4 HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP). December 2022. Agency for Healthcare Research and Quality, Rockville, MD. http://datatools.ahrq.gov//hcup-fast-stats?type=subtab&tab=hcupfsse&count=3 5 Hoyert 2022.

6 Chen J, Cox S, Kuklina EV, Ferre C, Barfield W, Li R. Assessment of Incidence and Factors Associated with Severe Maternal Morbidity after Delivery Discharge among Women in the US. JAMA Network Open.

2021. doi:10.1001/jamanetworkopen.2020.36148 https://mchb.hrsa.gov/programs-impact/programs/maternal-health-awardees-fy19 https://dx.doi.org/10.15620/cdc:113967 http://datatools.ahrq.gov/hcup-fast-stats?type=subtab&tab=hcupfsse&count=3 http://datatools.ahrq.gov/hcup-fast-stats?type=subtab&tab=hcupfsse&count=3

HRSA-23-108 State MHI 4 state’s maternal health infrastructure through the leadership of the Maternal Health Task

Force.

On September 30, 2022, HRSA provided funding to a second cohort of State MHI award recipients through the State MHI and Data Capacity Program. Newly funded states include: Alabama, Arkansas, Colorado, Georgia, Indiana, Maine, Massachusetts, Minnesota, and Tennessee. This second cohort of states is funded through September

29, 2027. Funding for the second cohort is to implement all core State MHI components;

work to improve the collection, reporting, and analysis of Alliance for Innovation on

Maternal Health (AIM) data; and expand the reach of AIM within each state. In FY2023, this program will align with prior year activities and expand to new states. This funding opportunity will support up to 22 state-focused projects tasked with translating maternal health innovations and recommendations from ideas to action.

State MHI Technical Assistance and Capacity Building Support

HRSA launched the Supporting Maternal Health Innovation Program to provide technical assistance and support capacity building for the State MHI award recipients, as well as the Federal Office of Rural Health Policy’s Rural Maternity Obstetrics

Management Strategies (RMOMS) program. The University of North Carolina at Chapel

Hill was awarded the cooperative agreement and created the Maternal Health Learning and Innovation Center (MHLIC). The mission of MHLIC is to foster collaboration and learning among diverse stakeholders to accelerate evidence-informed interventions advancing equitable maternal health outcomes through engagement, innovation, and policy. MHLIC focuses its activities in the following areas of support:

• Capacity building,

• Resource development and dissemination, and

• Peer learning opportunities.

In addition to supporting the current State MHI recipients and the RMOMS recipients with information and capacity-building resources, coaching, and technical assistance, the MHLIC also serves as a national hub. It connects maternal health stakeholders across the country, cataloging and disseminating best practices related to maternal health improvement. The MHLIC provides a host of learning opportunities for the State

MHI and RMOMS recipients, as well as national stakeholders, including annual

Learning Institutes, individual coaching, and technical assistance webinars, and by hosting the annual National Maternal Health Innovation Symposium.

About MCHB and Strategic Plan

The HRSA MCHB administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and http://www.maternalhealthlearning.org/ http://www.maternalhealthlearning.org/

HRSA-23-108 State MHI 5 children with special health care needs. To achieve its mission of improving the health and well-being of America’s mothers, children, and families, MCHB is implementing a strategic plan that includes the following four goals:

Goal 1: Assure access to high quality and equitable health services to optimize health and well-being for all MCH populations

Goal 2: Achieve health equity for MCH populations

Goal 3: Strengthen public health capacity and workforce for MCH

Goal 4: Maximize impact through leadership, partnership, and stewardship

The State MHI program’s purpose and activities align with Goals 1, 2, and 3 of the

MCHB strategic plan. MCHB is committed to promoting equity in its health programs for mothers, children, and families.

To learn more about MCHB’s programs, investments and the bureau’s strategic plan, visit http://www.mchb.hrsa.gov.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

In addition to the usual monitoring and technical assistance (TA) provided directly to award recipients, HRSA program involvement will include:

• Providing oversight and subject matter expertise in the planning and development of the project;

• Participating, as appropriate, in conference calls, meetings, and technical assistance sessions that are conducted during the period of the cooperative agreement;

• Coordinating the partnership and communication with federally funded maternal health programs and other federal entities that may be relevant for the successful completion of tasks and activities identified in the approved scope of the cooperative agreement;

http://www.mchb.hrsa.gov/

HRSA-23-108 State MHI 6

• Conducting an ongoing review of the establishment and implementation of activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement;

• Reviewing and providing input on written documents, including information and materials for the activities conducted through the cooperative agreement, prior to submission for publication or public dissemination; and

• Participating with the award recipient in the dissemination of project findings, best practices, and lessons learned from the project.

In addition to adhering to all applicable federal regulations and public policy requirements, the cooperative agreement recipient’s responsibilities will include:

• Completing activities proposed in response to the Program Requirements and

Expectations section of this notice of funding opportunity;

• Providing the federal project officer with the opportunity to review and discuss any publications, audiovisuals, and other materials produced, as well as meetings planned, through this cooperative agreement (such review should start as at the time of concept development and include review of drafts and final products);

• Participating in technical assistance and capacity building activities provided by the designated TA provider(s), including participation at an annual meeting hosted by the TA provider(s);

• Participating in face-to-face meetings, virtual meetings, and conference calls with

HRSA conducted during the period of performance;

• Consulting with the federal project officer in conjunction with scheduling any meetings that pertain to the scope of the cooperative agreement and at which the project officer’s attendance would be appropriate (as determined by the project officer);

• Adherence to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the Application Guide (Acknowledgement of Federal Funding);

• Collaborating with HRSA on ongoing review of activities, procedures and budget items, information/publications prior to dissemination, contracts, and subawards;

• Providing leadership in data collection and analysis;

• Participating in evaluation activities provided by the HRSA-designated evaluation contractor;

• Completing all administrative data and performance measure reports, as

HRSA-23-108 State MHI 7 designated by HRSA, and in a timely manner; and

• Collaborating with their state’s Maternal and Child Health Title V Director(s).

• Ability to remain flexible and collaborate with HRSA to adjust responsibilities as necessary

2. Summary of Funding

HRSA estimates approximately $23,000,000 to be available annually to fund up to 23 recipients. You may apply for an annual funding amount based on the total number of annual births within the state, as indicated in the table below, with a ceiling amount of up to $2,000,000 annually (reflecting direct and indirect costs) per year for applicants with more than 200,000 annual births within the state.

Total Number of Annual Births within the State

Annual Funding Amount

<50,000 Up to $1,000,000

50,000 - 200,000 Up to $1,500,000

>200,000 Up to $2,000,000

Please reference Table 6 in the National Vital Statistics Reports, Volume 70, No. 17, which provides the number of births by state for 2020 in your application.7

The period of performance is September 30, 2023 through September 29, 2028 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for the State MHI program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost

Principles, and Audit Requirements at 45 CFR part 75.

7 National Vital Statistics Reports Volume 70, Number 17, February 7, 2022 (cdc.gov) http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf

HRSA-23-108 State MHI 8

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C. 5304 (formerly cited as

25 U.S.C. 450b)). See 42 CFR § 51a.3(a). Domestic faith-based and community-based organizations are also eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Existing award recipients under the FY19 and FY22 State MHI Program funding opportunity are eligible to apply for funding under this announcement and, if funded, the existing State MHI award will be relinquished, and a new award period will begin. If an existing recipient applies but is not awarded funding under this announcement, the existing award will continue at the original level of funding through the project period end date.

Only one project will be funded per state under this notice.

Multiple Applications

Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date.

HRSA-23-108 State MHI 9

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through

Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO

APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov:

APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-108 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements

Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, and certifications. You must submit the information outlined in HRSA SF-424 Application

Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in this NOFO and HRSA’s SF-424

Application Guide. You must submit the application in the English language and budget figures expressed in U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the HRSA SF-424 Application Guide for the Application

Completeness Checklist to assist you in completing your application.

Application Page Limit

The total number of pages that count toward the page limit shall be no more than 55 pages when we print them. HRSA will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-23-108 State MHI 10

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

• Indirect Cost Rate Agreement

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

If there are other items that don’t count toward the page limit, we’ll make this clear in

Section IV.2.vi Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-108 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete and validated by Grants.gov under HRSA-23-108 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts

180 and 376, and 31 U.S.C. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 8: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications.

Program Requirements and Expectations

For this funding opportunity, applicants should propose projects that involve collaboration with a state public health agency to strengthen state-level capacity in achieving program aims. A letter of agreement and planned participation to document this relationship should be included as Attachment 4, if applicable.

1. Establish a State-Focused Maternal Health Task Force (MHTF)

To implement evidence-informed interventions that address critical gaps or disparities in the state’s provision of maternity care services, each program’s MHTF will be comprised of, but not limited to: state and local public health professionals

(e.g., State Department of Health, State Title V MCH Program, State Medicaid

Program); state Maternal Mortality Review Committee (MMRC) liaison(s); pregnant and postpartum individuals with lived experience; clinical providers, including midwives and doulas; hospitals; representatives of community organizations focused https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371

HRSA-23-108 State MHI 11 on reducing maternal mortality; insurers/payers; representatives from the state association of community health centers or primary care association; representatives of state and/or local corrections health care providers; and tribes/tribal organizations, if applicable.

Each Maternal Health Task Force is expected to:

• Conduct a baseline assessment of state maternal care and coverage.

Examples of assessment topics include: number and distribution of practicing

OB/GYNs, midwives, doulas, and family medicine providers providing maternal care in the state; an overview of payor mix and prenatal, birth, and postnatal benefit coverage in the state; number, distribution; and mix of birthing facilities across the state; etc.

• Identify state-specific gaps, based on the findings from MMRC reports and publications, that impact maternal health outcomes. Examples of critical gaps include, but are not limited to: limited state-level surveillance efforts to monitor maternal health; lack of access to quality prenatal and maternity care services in medically underserved areas; and/or inadequate access to mental and behavioral health specialists to screen and treat depression or substance use disorders among pregnant and postpartum people.

• Assist MHI program staff to develop and implement a state-focused strategic plan that is aligned with the state’s most recent comprehensive five-year Title

V Needs Assessment. The strategic plan should consist of an action plan that reflects strategies to improve maternal health, addresses identified gaps, and translates knowledge and recommendations into practice. It should include vision, strategic goals, and measurable, strategic objectives.

o The action plan should align with and enhance existing maternal health improvement efforts of the State Title V MCH Block Grant.

o The strategic plan should be considered a guiding document the Task

Force uses to direct all Task Force activities throughout the period of performance.

• Support state and community-level maternal health improvement efforts.

• Provide education and technical assistance in support of state and local action to address critical gaps in and needs for maternal health services in the state.

The MHTF may be a part of an existing statewide task force focused on improving maternal health. However, the award recipient is expected to ensure the MHTF is involved in the development of the State MHI program’s strategic plan and implementation of activities outlined within its action plan, as described above.

HRSA-23-108 State MHI 12

2. Improve State-Level Maternal Health Data and Surveillance

Access to state-level maternal health data is important for identifying the contributors to adverse maternal health outcomes. Specifically, successful recipients will be expected to identify and collaborate with a multidisciplinary state-focused MMRC or other state-focused initiative that can collect, analyze, and report data on pregnancy-related mortality, SMM, and/or other indicators of maternal health. Award recipients are expected to utilize state-level data to evaluate preventability, identify actionable recommendations, and improve systems of prenatal and maternity care services.

Award recipients could improve state-level maternal health data collection, quality, and surveillance through one or more of the following activities:

1. Support the implementation of recommendations from a state-focused MMRC or other state-focused mechanism that conducts surveillance on maternal health data. Please note that these funds are not to be used solely to support MMRCs, but to allow for implementation of recommendations from the state MMRC or a similar mechanism that conducts maternal health data surveillance.

2. Utilize valid and reliable data on maternal health to:

a. Improve maternal health data quality and timeliness.

b. Examine additional indicators, like social determinants of health, and analyze the data in relation to maternal health.

c. Assess other indicators of maternal health, including SMM, and the disparities in these indicators.

3. Improve data linkages to support surveillance activities.

4. Collaborate with the State Systems Development Initiative (SSDI) award recipient in their state to build maternal health data capacity and infrastructure.

5. Use annual maternal health data to implement innovative approaches aimed at addressing identified needs and disparities, and to provide recommendations aimed at improving maternal health.

3. Promote and Execute Innovation in Maternal Health Service Delivery

Award recipients are expected to use program funding to identify and implement innovative strategies to address critical gaps in prenatal and maternity care services in one or more of the following areas:

1. Direct clinical care;

2. Workforce training, recruitment, and diversity;

HRSA-23-108 State MHI 13

3. Maternal health data enhancements; and/or

4. Community engagement.

Please see the Appendix A for example of potential innovative approaches to improve maternal health service delivery. Strategies should be culturally responsive and linguistically appropriate.

Program Objectives

Please reference the program objectives as outlined in the Purpose of this Notice of

Funding Opportunity.

It is HRSA’s expectation that if you are awarded under this notice you will begin or continue a collaborative relationship with other federally funded programs that support maternal health, to include:

• HRSA’s AIM program and AIM Community Care Initiative (CCI), where applicable. AIM CCI is developing maternal safety bundles and resources for use in community-based organizations across the country. AIM CCI has also developed a Racial Equity Learning Series, a professional learning series to address racism’s impact on maternal health and beyond, as well as a Clinical

Community Integration Toolkit.

• HRSA-funded Maternal Health Learning and Innovation Center (MHLIC).

The MHLIC directly supports 21 HRSA-funded collaborating partners in 18 states and three rural regions with information and capacity-building resources.

• Maternal Mortality Review Committee (MMRC). You are expected to collaborate with Your state’s MMRC, where applicable, to understand leading causes of pregnancy-related deaths and inform prioritization of maternal health innovations and implementation efforts under this award.

• Enhancing Reviews and Surveillance to Eliminate Maternal Mortality

(ERASE MM) Program. If your state or U.S. territory receives CDC funding for the ERASE MM Program, you will be expected to collaborate with the ERASE

MM project team. The ERASE MM Program directly supports agencies and organizations that coordinate and manage MMRCs to identify, review, and characterize pregnancy-related deaths and to identify prevention opportunities, HRSA recommends that award recipients collaborate with state perinatal quality collaboratives, of which CDC provides funding for the technical assistance through the

National Network of Perinatal Quality Collaboratives (NNPQC). The NNPQC is funded to support state-based perinatal quality collaboratives in making measurable improvements in statewide health care and health outcomes for mothers and babies.

State MHI award recipients are also encouraged to work closely with the CDC on any https://www.aimcci.org/nhsa-aim-cci-racial-equity-learning-series-rels/

HRSA-23-108 State MHI 14 efforts to advance Levels of Maternal Care (LoMC) and use of their Levels of Care

Assessment Tool (LOCATe). In addition, HRSA recommends that award recipients collaborate with the Indian Health Service when supporting program implementation within tribal communities, and support CMS with the advancement of their Birthing

Friendly hospital designation.

HRSA encourages recipients to incorporate telehealth services as a component of their project demonstrations, where appropriate. The National Consortium of Telehealth

Resource Centers (TRCs) provides assistance, education, and information to organizations and individuals who are actively providing or interested in providing health care at a distance. Telehealth has been used successfully with pregnant and postpartum people to expand their access to essential services, information, and resources with text messaging, mobile applications, and private and secure video conferencing through smartphones, tablets, and computers with webcams. Telehealth can also address workforce gaps. For example, maternal telehealth programs currently support pregnant and postpartum people with accessing clinical health specialists for the screening and treatment of postpartum depression, remote pregnancy monitoring of gestational diabetes, nutrition counseling, and lactation support.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424

Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract

Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact https://www.telehealthresourcecenter.org/ https://www.telehealthresourcecenter.org/ http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-23-108 State MHI 15

Narrative Section Review Criteria

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response

Evaluation and Technical Support

Capacity

(3) Evaluative Measures and

(4) Impact

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative

This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

▪ INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 Need

Briefly describe the purpose of the proposed project that is consistent with Section

I: Purpose.

▪ NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 Need

Outline the maternal health needs of the state. Describe and document the target population, its unmet health needs, and how those unmet health needs contribute to maternal mortality, SMM, and other maternal health outcomes. Use and cite demographic data whenever possible to support the information provided.

o Identify and describe maternal health indicators at the state-level. Include the total number of live births; total number of pregnancy-related deaths;

maternal or pregnancy-related mortality rate (per 100,000 live births);

rate of SMM (per 10,000 deliveries); and other related maternal health measures (e.g., percentage of women with health insurance, median age at time of birth, rate of cesarean section deliveries, percentage of women who received a postpartum visit, percentage of women screened for postpartum depression) using the most recent data available, and identifying the year(s) of data used.

o Describe the geographic and demographic disparities in maternal health indicators and the social determinants of health (SDOH), within the state.

HRSA-23-108 State MHI 16 o Describe the maternal health services landscape in the state with respect to access, distribution of providers, type of providers, and payer mix.

o Describe any ongoing state-led initiatives to improve maternal health

(e.g., Title V maternal health priorities or activities from the Title V action plan, activities to improve maternal health data through SSDI, State-led

Perinatal Quality Collaborative, State MMRC, or other state-focused initiative to collect, analyze, and report maternal morbidity and mortality data).

o Demonstrate knowledge of current innovative, evidence-informed strategies within the state to improve maternal health and reduce maternal mortality and SMM.

o Describe existing efforts utilizing telehealth and telemedicine strategies to improve maternal health, if applicable.

o Discuss any relevant barriers in the state that the project hopes to overcome.

o Describe the current capacity to collect, report, and analyze high quality and timely data; and the state’s current capacity to collect and report data on race, ethnicity, and social determinants to assess the impact of the program on health equity and health disparities.

▪ METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 Response and

#4 Impact o Propose methods that you will use to address the stated needs to meet each of the previously described Program Requirements and

Expectations in this NOFO.

o Outline and discuss the maternal health data collection, analysis, and review process that will be used to gather requested state-level measures.

o Specifically, outline the framework for and establishment of the state-focused MHTF, its membership, partnership goals, and how the MHTF will engage and support implementation of project activities.

o If the work of the MHTF requires approval by a state-level government entity, include a letter of agreement from the entity as an attachment.

o Outline the process for the development of the Maternal Health Strategic

Plan (MHSP) and describe how the MHTF will be involved in implementing strategies.

HRSA-23-108 State MHI 17 o Provide Specific, Measurable, Achievable, Realistic, Time-bound, Inclusive, and Equitable (SMARTIE) objectives for each proposed project goal, as applicable.

Program Planning o Describe plans to provide leadership as convener/collaborator in advancing state maternal mortality efforts.

o Describe plans to center health equity as an ongoing component of all program activities.

o Describe plans to include the input of pregnant and postpartum individuals with lived experiences in program development and implementation.

o Describe the various strategies and activities that the state will implement to achieve project goals. Include any innovative methods that you will use to address the stated needs.

o Describe plans for utilizing telehealth and telemedicine strategies to reduce maternal mortality and SMM, if applicable.

o Propose a plan for project sustainability after the period of federal funding ends.

Program Implementation & Collaboration o Describe plans to assure alignment with and enhancement of existing

State Title V MCH Block Grant maternal health efforts, as well as plans to avoid duplication of existing efforts.

o Describe plans to collaborate with the SSDI award recipient in your state to build data capacity and infrastructure.

o Describe the plans and activities that will be implemented to foster collaborative learning with traditional and non-traditional partners, including tribes/tribal organizations.

Maternal Health Data Capacity o Describe plans to assure access to state/jurisdictional maternal mortality or pregnancy-related death data and other population health data related to maternal health.

o Discuss plans to disaggregate maternal health indicators and outcomes by maternal race/ethnicity, age, level of education, health insurance coverage, and geographic location (urban/rural).

HRSA-23-108 State MHI 18

▪ WORK PLAN -- Corresponds to Section V’s Review Criteria #2 Response and #4

Impact

Describe the activities or steps that you will use to achieve each of the objectives proposed during the entire period of performance in the Methodology section.

Incorporate a timeline that includes each activity and identifies responsible staff.

As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including developing the application. HRSA recommends that you submit a work plan in table format as Attachment 1 and include all of the information and activities detailed in the Project Narrative and Program Requirements and Expectations sections of the application.

▪ RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2 Response

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

If the applicant organization is a non-state entity, please discuss how coordination will occur between the award recipient and state agency involved in maternal health data collection. A letter of agreement should be included as Attachment 4.

▪ EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criteria #3 Evaluative Measures and #4 Impact o Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project.

o Describe the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities.

o Describe the systems and processes that will support your organization's performance management requirements through effective tracking of performance outcomes, including a description of how the organization will collect and manage data (e.g., assigned skilled staff, data management software) in a way that allows for accurate and timely reporting of performance outcomes.

HRSA-23-108 State MHI 19 o Describe the data collection strategy to collect, analyze, and track data to measure process and impact, and explain how the data will be used to inform program development and implementation of program activities.

o Describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

▪ ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion #5 Resources/Capabilities o Succinctly describe your organization’s current mission and structure, the scope of current activities, and how these elements contribute to the organization’s ability to conduct the program requirements and meet program expectations. Include a project organizational chart as

Attachment 5.

o Describe project personnel, including proposed partners that will be engaged to fulfill the needs and requirements of the proposed project.

Include relevant training, qualifications, expertise, and experience of staff to implement and carry out this project. Include a staffing plan and job descriptions for key personnel in Attachment 2, and biographical sketches of key personnel in Attachment 3. The Staffing Plan

(Attachment 2) should include a detailed staffing model that supports large-scale program implementation. The model should list staff titles, number of FTEs fulfilling the role, roles and responsibilities of each position.

o Provide a list of proposed partners for the MHTF and identify partner roles and responsibilities for program implementation. Include letters of agreement (e.g., State Title V MCH Agency) and/or descriptions of proposed/existing project-specific contracts in Attachment 4.

o Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

o Describe the organization’s relationships to the State Title V MCHB

Block Grant Program and demonstrate any collaborative commitments

(Attachment 4) with the State Maternal and Child Health Title V Director

(if the applicant is a non-state agency), organizations or individuals representing people who have experienced adverse pregnancy outcomes, and any other organization or entity with a focus on addressing maternal health (e.g., Healthy Start, state perinatal quality

HRSA-23-108 State MHI 20 collaboratives, state hospital association, professional organizations) with which you plan to partner, collaborate, coordinate efforts, or receive consultative services from, while conducting project activities.

o Describe the organization’s capacity to collect, analyze, and track data to measure process and impact, and explain how the data will be used to inform program development and implementation.

iii. Budget

The directions offered in the SF-424 Application Guide may differ from those offered by

Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application

Guide and the additional budget instructions provided below. A budget that follows the

Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and…