MCHB HRSA-24-039 (UK7) and HRSA-24-040 (U44) MCH-IOHI__Modified 10-31.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Maternal and Child Health Bureau

Division of Child, Adolescent, and Family Health

Maternal and Child Health – Improving Oral Health Integration Demonstration Projects (MCH-IOHI Projects)

Funding Opportunity Number: HRSA-24-039 and

Maternal and Child Health – Improving Oral Health Integration National Consortium (MCH-IOHI Consortium)

Funding Opportunity Number: HRSA-24-040

Funding Opportunity Type(s): Competing Continuation, New

Assistance Listing Number: 93.110

Application Due Date: January 22, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: October 16, 2023

Modified on October 25, 2023 to: clarify the Estimated and type of Award in the Summary on page iii and in section II.2. Award Information, and to correctly identify the reference supporting the definition of Underserved

Communities in Appendix B.

Modified on 10/31 – updated Grants.gov Links on Page 8 Pamella Vodicka Senior Public Health Analyst Call: 301-443-2753 Email: pvodicka@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:pvodicka@hrsa.gov https://www.govinfo.gov/content/pkg/COMPS-8759/pdf/COMPS-8759.pdf

HRSA-24-039 / HRSA-24-040 i

508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Number:

Title

HRSA-24-039: Maternal and Child Health – Improving Oral Health Integration Demonstration Projects (MCH-IOHI Projects)

Funding Opportunity Number:

Title

HRSA-24-040: Maternal and Child Health – Improving Oral Health Integration National Consortium (MCH-IOHI Consortium)

Assistance Listing Number: 93.110

Due Date for Applications: January 22, 2024

Purpose: The program’s purpose is to integrate preventive oral health care into primary care services accessible to MCH populations living in communities underserved by oral health care.

Program Objective(s): HRSA-24-039: MCH-IOHI Projects

1. By June 2028, 85% of the MCH-IOHI Project teams will report enhanced state-level policy and/or scopes of practice aimed to increase access and use of integrated preventive oral health care.

2. By June 2028, MCH-IOHI Project teams will report increased oral health awareness among 85% of the health organizations across the state targeted for organizational oral health literacy training and outreach.

3. By June 2028, 85% of the MCH-IOHI Project teams will implement state-level oral health surveillance enhancements aimed to improve trend analysis.

HRSA-24-039 / HRSA-24-040 ii

4. By June 2028, 100% of participating primary care settings will implement an evidence-based model of care aimed to integrate preventive oral health care and primary care services, to include: primary care clinic workflow modifications, provider training, and dental referral tracking.

HRSA-24-040: MCH-IOHI Consortium

1. By June 2028, 85% of the MCH-IOHI Project teams will perceive that the right amount of time, expertise, and resources are invested in their collaboration efforts aimed to sustain successful aspects of the project.

2. By June 2028, 85% of the Consortium recipients of universal TA will have applied their new oral health knowledge and/or skill.

3. Annually update/develop and disseminate at least eight evidence-based or informed educational resources that respond to resource needs among MCH-IOHI Project teams and other individuals or organizations serving the oral health needs of MCH populations.

Eligible Applicants: You can apply if your organization is in the United States and is:

• Public or private

• Community-based

• Tribal (governments, organizations)1

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

Anticipated FY 2024Total Available Funding:

Total Annual Funding: Up to $4,450,000

• MCH-IOHI Projects: $2,975,000

1 For awards authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), see also 42 CFR § 51a.3(a).

HRSA-24-039 / HRSA-24-040 iii

• MCH-IOHI Consortium: $1,475,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds aren’t appropriated.

Estimated Number and Type of Award(s):

MCH-IOHI Projects: Up to 7 new cooperative agreements in seven different states

MCH-IOHI Consortium: One new cooperative agreement

Estimated Annual Award Amount:

MCH-IOHI Projects: $425,000

MCH-IOHI Consortium: $1,475,000

Subject to the availability of appropriated funds.

Cost Sharing or Matching Required:

No

Period of Performance: July 1, 2024 through June 30, 2028 (4 years)

Agency Contacts: Business, administrative, or fiscal issues:

Amy Glasser Grants Management Specialist Division of Grants Management Operations, OFAM Email: aglasser@hrsa.gov Program issues or technical assistance:

Pamella Vodicka Senior Public Health Analyst Maternal and Child Health Bureau Email: pvodicka@hrsa.gov

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA Application Guide (Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

mailto:aglasser@hrsa.gov mailto:pvodicka@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

HRSA-24-039 / HRSA-24-040 iv

Technical Assistance

We have scheduled the following webinars for the two separate project competitions (one for each competition) announced in this NOFO:

HRSA-24-039: Maternal and Child – Improving Oral Health Integration Demonstration Projects (MCH-IOHI Projects)

Wednesday, November 1, 2023 3 p.m.— 4 p.m. ET Weblink:

https://hrsa-gov.zoomgov.com/j/1614733287?pwd=V2t6YnMraTdFMnY5SGNoVDNmekJRdz09

Attendees without computer access or computer audio can use the following dial-in information:

Call-In Number: 1-833-568-8864 Meeting ID: 55075449

HRSA-24-040: Maternal and Child – Improving Oral Health Integration National Consortium (MCH-IOHI Consortium)

Thursday, November 2, 2023 3 p.m.— 4 p.m. ET Weblink:

https://hrsa-gov.zoomgov.com/j/1617052987?pwd=aGxpNHhXQ2t0THZyZ29XN0Q1QTVLdz09

Attendees without computer access or computer audio can use the following dial-in information:

Call-In Number: 1-833-568-8864 Meeting ID: 82656071

We’ll record the webinar and include closed captioning. You can access the recording here.

https://hrsa-gov.zoomgov.com/j/1614733287?pwd=V2t6YnMraTdFMnY5SGNoVDNmekJRdz09 https://hrsa-gov.zoomgov.com/j/1614733287?pwd=V2t6YnMraTdFMnY5SGNoVDNmekJRdz09 https://hrsa-gov.zoomgov.com/j/1617052987?pwd=aGxpNHhXQ2t0THZyZ29XN0Q1QTVLdz09 https://hrsa-gov.zoomgov.com/j/1617052987?pwd=aGxpNHhXQ2t0THZyZ29XN0Q1QTVLdz09 https://www.hrsa.gov/grants/find-funding?search=&status=All&bureau=248

HRSA-24-039 / HRSA-24-040 v

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 OR 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

2. REVIEW AND SELECTION PROCESS

3. 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: PAGE LIMIT WORKSHEET

APPENDIX B: HHS AND HRSA DEFINITIONS

HRSA-24-039 / HRSA-24-040 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Maternal and Child Health (MCH) – Improving Oral Health Integration (MCH-IOHI) Program. The program’s purpose is to integrate preventive oral health care into primary care services accessible to MCH populations living in communities underserved2 by oral health care.

The MCH-IOHI Program consists of two types of projects. This announcement includes application instructions for the two separate project competitions. You may only apply for HRSA-24-039 or HRSA-24-040, but not both awards.

HRSA-24-039: MCH-IOHI Demonstration Projects (MCH-IOHI Projects)

MCH-IOHI Projects will aim to improve access to integrated preventive oral health care (integrated POHC) in primary care services accessible to MCH populations at increased or higher risk for poor oral health. Funding will support an MCH-IOHI Alliance (Alliance), to include key state stakeholders such as policy, practice, and public health leaders;

healthcare providers; healthcare payers; and public health surveillance experts. The Alliance will implement a two-tier, state and local, improvement approach that’ll address three core functions: 1) Policy and Practice; 2) Education and Outreach; and 3) Data, Analysis and Evaluation. State level improvements, in support of the local approach, will aim to inform state policy and practice decisions that promote integrated POHC (such as Medicaid payment for oral health services and health professions’ state practice acts);3 increase oral health literacy4 across the state using an organizational health literacy approach;5 and enhance the state’s oral health surveillance (for example, data collection and trends analysis). The local improvement approach will aim to establish, implement, and validate evidence-based models of integrated POHC in communities underserved by oral health care. MCH-IOHI Projects will take part in an MCH-IOHI Consortium-led learning collaborative.

HRSA-24-040: MCH-IOHI Consortium (Consortium)

The Consortium will bridge the gap between evidence and practice. As the principal technical assistance (TA) provider, the Consortium will accelerate the adoption and implementation of evidence-based integrated POHC strategies that aim to advance

2 See appendix for definition.

3 James W. Hilliard & Marjorie E. Johnson, State Practice Acts of Licensed Health Professions: Scope of Practice, 8 DePaul J. Health Care L. 237 (2004) 4 Kleinman DV, Horowitz AM and Atchison KA (2021) A Framework to Foster Oral Health Literacy and Oral/General Health Integration. Front. Dent. Med. 2:723021.

5 Office of Disease Prevention and Health Promotion. National Health Initiatives (NIH): Health Literacy.

[August 24, 2021] Health Literate Care Model. U.S. Department of Health and Human Services (HHS).

Accessed June 1, 2023, here.

https://health.gov/our-work/national-health-initiatives/health-literacy/health-literate-care-model

HRSA-24-039 / HRSA-24-040 2

health equity.6 The Consortium will provide targeted TA, using implementation science and collaborative learning, to strengthen an MCH-IOHI Project team’s two-tier, state and local, improvement approach. The Consortium will also provide universal TA that’s easily accessible to all states and jurisdictions.7 Universal TA will include the development and dissemination of evidence-based/-informed preventive oral health care resources and guidance.

Program Goals are to improve access to preventive oral health care and oral health equity among MCH populations living in communities underserved by oral health care.

The Program Objectives, to accomplish during the period of performance, include:

HRSA-24-039: MCH-IOHI Demonstration Projects

1. By June 2028, 85% of the MCH-IOHI Project teams will report enhanced policy and/or scope of practice aimed to increase access and use of integrated preventive oral health care.

2. By June 2028, MCH-IOHI Project teams will report increased oral health awareness among 85% of the health organizations across the state targeted for organizational oral health literacy training and outreach.

3. By June 2028, 85% of the MCH-IOHI Project teams will implement state-level oral health surveillance enhancements aimed to improve trend analysis.

4. By June 2028, 100% of participating primary care settings will implement an evidence-based model of care aimed to integrate preventive oral health care and primary care services, to include: primary care clinic workflow modifications, provider training, and dental referral tracking.

HRSA-24-040: MCH-IOHI National Consortium

1. By June 2028, 85% of the MCH-IOHI Project teams will perceive that the right amount of time, expertise, and resources are invested in their collaboration efforts aimed to sustain successful aspects of the project.

2. By June 2028, 85% of the Consortium recipients of universal TA will have applied their new oral health knowledge and/or skill.

3. Annually update/develop and disseminate at least eight evidence-based or informed resources that respond to resource needs among MCH-IOHI Project teams and other individuals or organizations serving the oral health needs of MCH populations.

6 See appendix for definition.

7 For purposes of this NOFO, “all states and jurisdictions” include the 50 United States and the following nine jurisdictions: District of Columbia, Republic of the Marshall Islands, Federated States of Micronesia, Republic of Palau and U.S. territories of the Commonwealth of Puerto Rico, Virgin Islands, Guam, American Samoa, and Commonwealth of the Northern Mariana Islands.

HRSA-24-039 / HRSA-24-040 3

For more details, see Program Requirements and Expectations.

2. Background

HRSA-24-039, the Maternal and Child Health – Improving Oral Health Integration Demonstration Projects and HRSA-24-040, the Maternal and Child Health – Improving Oral Health Integration National Consortium (Consortium) are both authorized by 42 U.S.C § 701(a)(2) (Title V, §501(a)(2) of the Social Security Act).

Program Background

In the United States, pregnant individuals and children who live in low-income, historically underserved communities lack access to oral health care.8,9 Less than half of pregnant women in the United States report having had a dental cleaning during pregnancy, and that number is much lower among socially disadvantaged women.10 Children from low-income families are twice as likely to have untreated cavities as children from higher-income families.11 And Mexican American and non-Hispanic black children have untreated cavities at a higher rate than non-Hispanic white children.11 Research shows gum disease, reported to be common during pregnancy, can increase the odds of maternal complications.12 During childhood, untreated cavities are associated with school absenteeism and lower academic achievement.13

An upstream approach to address disparities in oral health and access to oral health services has been to expand integrated POHC in primary care settings to reduce the risk of oral health problems, such as caries, and ensure linkages to oral health care, when needed.14 HRSA elevated the focus on integrated POHC with the 2014 release of

8 Al Jallad N, Vasani S, Wu TT, Cacciato R, Thomas M, Lababede N, Lababede A, Xiao J. Racial and oral health disparity associated with perinatal oral health care utilization among underserved US pregnant women. Quintessence Int. 2022 Oct 21;53(10):892-902.

9 Corr A, Wenderoff J. Inequitable Access to Oral Health Care Continues to Harm Children of Color.

Analysis of outcomes among third-graders highlights gaps in data. Pew Charitable Trust. [March 11, 2022] Accessed June 1, 2023, here.

10 Centers for Disease Control and Prevention (CDC). PRAMS. Prevalence of Selected Maternal and Child Health Indicators for All Pregnancy Risk Assessment Monitoring System (PRAMS) Sites, 2016– 2020. HHS. [March 28, 2023] Accessed June 1, 2023, here.

11 CDC. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Atlanta, GA: CDC, US Dept of Health and Human Services (HHS); 2019.

12 Starzyńska A, Wychowański P, Nowak M, Sobocki BK, Jereczek-Fossa BA, Słupecka-Ziemilska M.

Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring. Int J Mol Sci. 2022 Feb 24;23(5):2473.

13 Ryan RR, Sashendra S, Stephanie RS, Atsuko T. Oral health, academic performance, and school absenteeism in children and adolescents: A systematic review and meta-analysis. J Am Dent Assoc.

2019 Sept;150(2): 111-121.

14 Harnagea H, Lamothe L, Couturier Y, Esfandiari S, Voyer R, Charbonneau A, Emami E. From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care. BMC Oral Health. 2018 Feb 15;18(1):23.

https://www.govinfo.gov/content/pkg/COMPS-8759/pdf/COMPS-8759.pdf https://www.pewtrusts.org/en/research-and-analysis/articles/2022/03/11/inequitable-access-to-oral-health-care-continues-to-harm-children-of-color https://www.cdc.gov/prams/

HRSA-24-039 / HRSA-24-040 4

Integration of Oral Health and Primary Care Practice,15 which aimed to support integrated POHC in primary care services, especially for populations that lacked access to oral health services. Based on that report, we funded, in 2019, the Networks for Oral Health Integration (NOHI) Within the Maternal and Child Health Safety Net program to further develop and test models of integrated POHC in primary care settings. These projects improved access to quality preventive oral health care among MCH populations in 70 clinics across 12 states. With one year left in the period of performance, NOHI sites have provided clinical competency training to almost 2000 non-dental primary care providers. The delivery of integrated POHC during a primary care visit at NOHI sites increased from 10%, in 2021, to 61%, in 2023. In total, over 225,000 integrated preventive oral health care services were received by the MCH population served including nearly 85,000 risk assessments, over 82,000 fluoride varnish treatments, nearly 21,000 dental sealant applications, and over 37,000 oral health referrals. In sum, the NOHI projects demonstrate that with adequate funding and TA support, primary care providers can increase access to integrated POHC services.

In addition to changes in practice models and provider skills, other effective approaches to advancing integrated POHC include enhancing both Medicaid payments for oral health care and the scope of state practice acts.16,17 Because the levers of improving access to preventive oral health care services vary by state,18 specific TA expertise is needed that can deal with the policy issues, educational needs, and surveillance capacity that are unique to each state. This work is necessary to support and sustain long term integrated POHC.19 Finally, reporting reduction of oral health disparities will rely on recording progress towards expanding access to integrated preventive oral health care and the oral health improvements that result from these efforts, which will require enhancements in data collection and surveillance.20

About MCHB and Strategic Plan

Our Maternal and Child Health Bureau (MCHB) administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and children with special health care needs. To achieve its mission of improving the health and well-being of America’s mothers, children, and families, 15 Health Resources and Services Administration (HRSA). Integration of Oral Health and Primary Care.

HHS. [February 2014] Accessed May 15, 2023, here.

16 American Public Health Association. Improving Access to Dental Care for Pregnant Women through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research. Policy No. 20203. [October 24, 2020] Accessed March 15, 2023, here.

17 Lipton BJ, Decker SL, Stitt B, Finlayson TL, Manski RJ. Association Between Medicaid Dental Payment Policies and Children’s Dental Visits, Oral Health, and School Absences. JAMA Health Forum.

2022;3(9):e223041.

18 American Dental Association. Dental coverage, access & outcomes. Reimbursement rates for child and adult dental services in Medicaid by state. [October 2021] Accessed March 15, 2023, here.

19 Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annu Rev Public Health.

2020 Apr 2;41:513-535.

20 Herndon, JB, Ojha, D. Racial and ethnic disparities in oral healthcare quality among children enrolled in Medicaid and CHIP. J Public Health Dent. 2022; 82(Suppl. 1): 89– 102.

https://www.hrsa.gov/sites/default/files/hrsa/oral-health/integration-oral-health0.pdf https://mchb.hrsa.gov/programs-impact/oral-health https://mchb.hrsa.gov/programs-impact/oral-health https://www.hrsa.gov/sites/default/files/hrsa/oralhealth/integrationoforalhealth.pdf https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2021/01/12/Improving-Access-to-Dental-Care-for-Pregnant-Women https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_1021_1.pdf?rev=1be8e91fb2df4c75ba2228870fd4fbc6&hash=931BF94DEC50012CC056B123BF99E884

HRSA-24-039 / HRSA-24-040 5

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

To learn more about MCHB and the bureau’s strategic plan, visit Mission, Vision, and Work | MCHBhttps://mchb.hrsa.gov/about-us/mission-vision-work.

II. Award Information

1. Type of Application and Award

Application type(s): New

We will fund you via a cooperative agreement.

A cooperative agreement is like a grant in that we award money, but we are substantially involved with program activities.

Aside from monitoring and technical assistance (TA), we also get involved in these ways:

• Participating, when appropriate, in meetings, conference calls, and other sessions conducted during the period of performance, including but not limited to, stakeholder meetings, TA sessions, and learning collaborative sessions.

• Reviewing and editing, as appropriate, written documents developed by the recipient prior to submission for publication or public dissemination.

• Participating with the recipient in the dissemination of project findings, best practices, and lessons learned, and in producing and jointly reviewing reports, articles, and/or presentations developed under this NOFO.

• Conducting site visits with the recipient during the period of performance.

• Assisting in the establishment of partnerships, collaboration, and cooperation that may be necessary to carry out the project, including other federal agencies or programs within HRSA.

• Monitoring performance measurement and evaluation data reported by recipients to track recipient progress, provide feedback to individual recipients, and assess (in an aggregate manner) whether our program is achieving intended program https://mchb.hrsa.gov/about-us/mission-vision-work%22%EF%B7%9FHYPERLINK%20%22https:/mchb.hrsa.gov/about-us/mission-vision-work https://mchb.hrsa.gov/about-us/mission-vision-work%22%EF%B7%9FHYPERLINK%20%22https:/mchb.hrsa.gov/about-us/mission-vision-work https://mchb.hrsa.gov/about-us/mission-vision-work

HRSA-24-039 / HRSA-24-040 6

outcomes. We will work together with the recipients after an award to finalize the performance monitoring and accountability approach.

• Monitoring the extent to which the products and services provided by the recipients meet needs identified by stakeholders.

You must follow all relevant federal regulations and public policy requirements. Your other responsibilities will include:

• Meeting with our project officer at the time of the award to review the current strategies and ensure the project and goals align with our priorities for this activity.

• Collaborating with our personnel in the planning and development of project activities including developing policies and procedures; identifying measures and data; identifying emerging issues; revising the monitoring and evaluation plan to address emerging needs; developing strategies and tools; and identifying topics for advisory committee meetings, learning collaboratives, publications, and other materials produced.

• Producing and disseminating project findings through publishing articles, reports and/or presentations; and adhering to our guidelines pertaining to acknowledgement and disclaimer on all products produced by our awards (see Acknowledgement of Federal Funding in Section 2.2 of HRSA’s SF-424 Application Guide).

• Leveraging existing products or resources to maximize efficiency and effectiveness and reduce duplication.

• Collaborating with all MCH-IOHI Program recipients (HRSA-24-039 and HRSA- 24-040) to meet the goals and objectives of the program.

2. Summary of Funding

HRSA-24-039, MCH-IOHI Projects

We estimate $2,975,000 will be available each year to fund up to 7 recipients in 7 different states for the MCH-IOHI Projects. You may apply for a ceiling amount of up to $425,000 annually (reflecting direct and indirect costs).

HRSA-24-040, the Consortium

We estimate $1,475,000 will be available each year to fund 1 recipient. You may apply for a ceiling amount of up to $1,475,000 annually (reflecting direct and indirect costs).

The period of performance for the MCH-IOHI Program (HRSA-24-039 and HRSA-24-

040) is July 1, 2024 through June 30, 2028 (4 years).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we’ll proceed with the application and award process.

HRSA-24-039 / HRSA-24-040 7

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

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

Note: Award recipients may request supplemental funding at any point during the period of performance to address unique project needs that are connected to, but not duplicative of, the funded project’s work plan. We may provide funding for such supplemental activities if funding is available and allocable, the request is reasonable and allowable, sufficient time remains in the budget period to approve the request, and the activities align with our priorities and do not duplicate work we or other HRSA funding recipients perform.

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is in the United States and is:

• Public or private

• Community-based

• Tribal (governments, organizations) 21

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

21 For awards authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), see also 42 CFR § 51a.3(a).

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-039 / HRSA-24-040 8

3. Other

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

• Exceeds the funding ceiling amount

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

Multiple Applications

You can only apply for the HRSA-24-039 (MCH-IOHI Projects) or HRSA-24-040 (Consortium). We will not consider applicants that apply for both awards.

We’ll only review your last validated application before the Grants.gov due date.

NOTE: A Consortium application must be submitted by the lead applicant. Each consortium partner must demonstrate substantial involvement and contribute significantly to the project’s goals. Each partner will be evident in the project organizational chart (Attachment 2). Roles and responsibilities of key consortium members (Attachment 3) must be clearly defined in a proposed Memorandum of Understanding/Agreement (MOU/A) that is supported in writing by all consortium members (Attachment 5)

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-039 or HRSA-24-040 to receive emails about changes, clarifications, or instances where we republish the NOFO. You’ll also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the Application Guide to help you.

https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-039 / HRSA-24-040 9

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. We will not review any pages that exceed the page limit.

Using the pages within the page limit, we’ll determine eligibility using Section III.

Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• 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 do not count toward the page limit, we’ll make this clear in Section IV.2.v Attachments.

If you use an OMB-approved form that is not in the HRSA-24-039 or HRSA-24-040 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-039 or HRSA-24-040 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals22 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.23

• If you cannot certify this, you must include an explanation in Attachment 11-15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the Application Guide)

Program Requirements and Expectations

In addition to the goal, purpose, and objectives of the MCH-IOHI Program listed above, successful MCH-IOHI applicants will also address two overarching expectations:

22 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

23 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

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 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 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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• A health equity approach will be evident, including a feasible work plan that’ll identify disparities in access and use of preventive oral health care and clearly describes attainable strategies that’ll address the disparities identified.

• The performance measurements, project evaluation, and quality improvement (QI) activities that you propose to assess progress towards the Program Objectives will include required measures (outlined below) along with key indicators that aim to measure the sustainability of the project.

The MCH-IOHI Program depends on a collaborative approach between the MCH-IOHI Projects and Consortium. For this reason, all applicants, for either the MCH-IOHI Project or Consortium awards, are encouraged to read all of the Purpose section, above, and the Program Requirements and Expectations, that continues below.

HRSA-24-039: MCH-IOHI Demonstration Project (MCH-IOHI Project)

The successful MCH-IOHI Project applicant will implement a two-tier improvement approach that will address three core functions at the state and local level: 1) Policy and Practice; 2) Outreach and Education; and 3) Data, Analysis, and Evaluation. We recommend a team effort to coordinate and implement all core function activities outlined below. Key personnel we suggest for the project are italicized.

Overarching MCH-IOHI Project Expectations

• Form an MCH-IOHI Alliance (Alliance) of key state stakeholders. We do not require a specific state stakeholder to participate. For example, a public health leader may represent the state Title V agency or oral health program, a state coalition, or other state advisory council whose focus includes oral health. We expect Alliance members to take leadership roles in the coordination, implementation, and evaluation of the two-tier, state and local improvement approach. We expect the Project Director will represent the applicant lead organization and, as the Alliance lead, will be responsible for the oversight of the MCH-IOHI Project. We expect the Alliance members will be responsible for identifying strategies to establish effective collaboration in support of and commitment to the program’s Purpose.

• Participate in a Consortium-led MCH-IOHI learning collaborative (LC) to foster consensus and a joint approach among the projects. For budget purposes, we expect the MCH-IOHI Projects and Consortium will plan for the following:

o Consortium-led coordination of common project activities, to show collective impact and progress, to include an agreed set of common metrics, common definitions, and methods for data collection and analyses of the project’s required measures (outlined below).

o Consortium-led agenda, including structured virtual LC learning sessions and follow up (such as six 60-to-90-minute virtual learning sessions that alternate with six structured team-based, check-in calls per year).

HRSA-24-039 / HRSA-24-040 11

o Virtual MCH-IOHI LC Kickoff (that can replace the first learning session in project year 1) to allow our project officer, in coordination with the Consortium, to review: (1) Program Requirements and Expectations, (2) the Consortium’s LC framework, and (3) annual reporting requirements.

o Annual, virtual or in-person MCH-IOHI meetings. For budget purposes, the MCH-IOHI Projects and Consortium will plan for no less than four key personnel to attend a 2-day, in-person annual meeting, in the Washington DC Metro area, for project years 1 and 4.

In addition, successful MCH-IOHI Project applicants will address the following:

State Level Approach

Your state level improvement approach will clearly implement the state core function activities, we outline below, as it aims to achieve the Purpose described above.

State Implementation (SI) – We expect Alliance members to take leadership roles in the coordination, implementation and evaluation of the state core function activities outlined below. We advise an SI Coordinator to provide oversight. We recommend a State Core Function (SCF) Lead for each core function to assist if the SI Coordinator could benefit from additional knowledge the SCF Lead(s) can offer.

State Core Function (SCF) 1: Policy and Practice – SCF 1 aims to inform state policy decisions.

• Complete the HRSA-funded Environmental Scan for Integrating Oral Health Care and Primary Care, to identify capacity factors that can impact access to integrated POHC services in your state. For budget purposes, complete an initial scan in project year 1; repeat in years 3 and 4 to identify improvements.

• Implement the HRSA-funded Capacity Inventory Tool for Integrating Oral Health Care and Primary Care for Pregnant Women, to identify policy and practice improvement opportunities. The Consortium will assist in the use of this tool for all MCH populations. You’ll identify no less than four improvement strategies to demonstrate a linkage between state level improvements and access. For budget purposes, plan to implement this tool in project year 1.

State Core Function (SCF) 2: Outreach and Education – SCF 2 aims to increase oral health literacy24 across the state using an organizational health literacy approach.25 For any state to participate, no matter size or geographic diversity, your plan to implement SCF 2 will include: (1) a sufficient geographic area to provide conclusive results that

24 Horowitz AM, Kleinman DV, Atchison KA, Weintraub JA, Rozier RG. The Evolving Role of Health Literacy in Improving Oral Health. Stud Health Technol Inform. 2020 Jun 25; 269:95-114..

25 Healthy People 2030. Health Literacy in HP 2030. Accessed June 1, 2023, here.

https://www.mchoralhealth.org/projects/nohi.php https://www.mchoralhealth.org/projects/nohi.php https://www.mchoralhealth.org/cohsii/integration-lc.php https://www.mchoralhealth.org/cohsii/integration-lc.php https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

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demonstrate improvement and (2) a realistic, measurable plan to scale up.26

• Implement an organizational oral health literacy knowledge gaps analysis of health organizations and the professionals they represent, include but do not limit to primary care settings. For budget purposes, plan to implement in project year 1; repeat in year 4 to demonstrate improvement.

• Develop and implement an organizational oral health literacy plan with QI measures27 and a realistic, measurable plan to scale up and spread statewide.

This plan can be one of your state level improvement strategies (see SCF 1).

State Core Function (SCF) 3: Data, Analysis, and Evaluation – SCF 3 aims to implement state level oral health surveillance improvements to enhance trend data.

• Implement state oral health surveillance enhancements28 to improve the monitoring of disparities in oral health status and burden of oral disease among MCH populations. For example, you can identify new oral health data or enhance expertise to better assess and report results. We expect the data to address social determinants of health,29 to include community level data if available. For budget purposes, plan to assess the effectiveness of your surveillance enhancements in project year 4. This plan can be one of your state level improvement strategies (see SCF 1).

Local Level Approach

Your local improvement approach will clearly implement the local core function activities outlined below, as it aims to implement, validate, and establish a replicable, evidence-based/-informed model of care that integrates preventive oral health and primary care.

We encourage a community-centered approach to preventive oral health care integration, that considers the social determinants of health and social inequities as barriers to care.30 While we do not require a specific MCH population type or a total number of primary care settings for participation in the MCH-IOHI Project, the project you propose will include a sufficient volume of the population being served to produce conclusive results that demonstrate progress towards the required measures using the agreed set of common metrics.

26 Greenhalgh T, Papoutsi C. Spreading and scaling up innovation and improvement. BMJ. 2019 May 10;365:l2068.

27 Agency for Healthcare Research and Quality. Health Literacy. Health Literacy Improvement Tools.

HHS. [December 2022] Accessed June 1, 2023, here.

28 CDC. Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion.

Oral Health Data Collection & Surveillance. HHS. [December 2020] Accessed March 15, 2023, here.

29 See appendix for definition.

30 National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop.

Washington, DC: The National Academies Press.

https://www.ahrq.gov/health-literacy/improve/index.html https://www.cdc.gov/oralhealth/funded_programs/infrastructure/datacollection.htm

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• Select an evidence-based/-informed model of integrated POHC for implementation and testing. A model of care that integrates preventive oral health care and primary care services15,31 will include at a minimum: an oral health risk assessment, oral health screening, oral health anticipatory guidance, preventive oral health care services (such as fluoride varnish), and dental referrals for non-urgent (maintenance) and urgent (comprehensive) treatment, as needed.

• Select one population type (the target population) from the population groups used in MCHB’s Reporting requirements (see Form 5): pregnant individuals (all ages) and/or infants (< 1 year), children (1–21 years), or children and youth with special health care needs (1–21 years). You’ll justify your selection with data.

• Select primary care settings in communities underserved by oral health care.

We encourage you to use dental workforce shortage designations we recognize to justify your selection.32 We expect you to begin with no less than three primary care settings to produce conclusive results that show progress.

Primary Care Integration (PCI) – We advise Alliance members take leadership roles in coordination, implementation and evaluation of the local core function activities outlined below. We recommend a PCI Coordinator provide oversight and guidance for all participating primary care settings. For each primary care setting we encourage you to designate a lead along with a PCI Team to oversee the implementation of integrated POHC. We encourage your PCI Teams include a medical and an oral health champion, and personnel with knowledge and skill in clinic management and clinical data analytics.

We advise a Local Core Function (LCF) Lead for each core function to assist if the PCI Coordinator could benefit from additional knowledge the LCF Lead(s) can offer.

Local Core Function (LCF) 1: Policy and Practice – LCF 1 aims to fully integrate POHC into primary care services.

• Modify clinic workflows to add preventive oral health services during a primary care visit at participating primary care settings. We encourage telehealth33 in your workflow modifications when feasible or appropriate. We also advise you to optimize use of supportive healthcare workers, for example community health workers, community navigators, promotores(as),34 or health educators.

• Implement a referral tracking process to determine receipt of oral health care.

31 Prasad M, Manjunath C, Murthy AK, Sampath A, Jaiswal S, Mohapatra A. Integration of oral health into primary health care: A systematic review. J Family Med Prim Care. 2019 Jun;8(6):1838-1845.

32 HRSA. Health Workforce. What is Shortage Designation. HHS. [June 2023] Accessed March 15, 2023, here.

33 See appendix for definition.

34 CDC. Minority Health. Promotores/Community Health Workers. HHS. [September 2019] Accessed March 15, 2023, here.

https://mchb.hrsa.gov/data-research/discretionary-grants-information-system-dgis https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation https://www.cdc.gov/minorityhealth/promotores/index.html

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• Identify QI tools (such as process mapping35) to assess workflow improvements, and a realistic, measurable plan to scale up. We expect you to expand your model of integrated POHC to new primary care settings to validate replicability.

Local Core Function (LCF) 2: Outreach and Education – LCF 2 aims to increase POHC knowledge and skill among non-dental primary care providers and improve oral health awareness among the target population.

• Implement an oral health knowledge and skill gaps analysis of the primary care providers and target population. For budget purposes, plan to implement in project year 1; repeat in year 4 to measure change.

• Develop and implement trainings to increase providers’ knowledge and skill. For example, you can choose an organizational health literacy approach to align this activity with your state level improvement strategy relevant to SCF 2 (see above).

• Develop preventive oral health care anticipatory guidance and client education, with the help of individuals with lived experience,36 to raise awareness among the target population.

Local Core Function (LCF) 3: Data, Analysis, and Evaluation – LCF 3 aims to enhance clinical data collection and analysis.

• Implement a realistic, measurable plan to capture meaningful clinical data across all primary care settings. Include demographic data when possible. Include a plan for documenting and reporting the project’s performance improvement, including progress towards the required measures using the agreed set of common metrics, common definitions, and methods to collect and analyze your data. You’ll collect and report bi-annually on the agreed set of common metrics.

We encourage you to identify metrics unique to your project in addition to the agreed set of common metrics.

Evaluating progress will need staff who are knowledgeable and skilled in data collection and analytics. We do not require you use electronic health records (EHRs). We do expect all primary care settings to revise reporting requirements, as needed, to identify delivery of integrated POHC services and to track dental referrals. If using EHRs, you may need to access experts who understand EHR interoperability. If relevant to your approach, see Health Information Technology (IT) Interoperability Requirements in the Administrative and National Policy Requirements section of this NOFO.

35 Institute for Healthcare Improvement. Improving Health and Healthcare Worldwide. Improvement Blog.

5 Steps for Creating Value Through Process Mapping and Observation. [October 1, 2015] Accessed May 15, 2023, here.

36 Office of Assistant Secretary for Planning and Evaluation. Engaging People with Lived Experience to Improve Federal Research, Policy, and Practice. HHS. Accessed August 1, 2023, here.

https://www.ihi.org/communities/blogs/5-steps-for-creating-value-through-process-mapping-and-observation https://aspe.hhs.gov/lived-experience

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HRSA-24-040: MCH-IOHI National Consortium (Consortium)

High-quality TA (that is TA based on evidence and best practices, delivered by trained personnel) can help bridge the gap between evidence, policy, and practice. As the principal TA provider, the Consortium will implement expert-led TA as described in the Purpose section and outlined below. The Consortium partners will have expertise and proven knowledge in providing targeted TA using implementation science and collaborative learning that’s responsive to the needs of MCHB’s oral health projects participating in a Consortium-led LC. In addition, the Consortium will provide universal TA easily accessible to all states and jurisdictions (that’s TA received by individuals or organizations through their own initiative or Consortium-led TA outreach). Universal TA includes the development and dissemination of evidence-based and -informed preventive oral health care resources and guidance. The Consortium’s TA approach will underscore the importance of establishing a shared vision among Consortium partners, clearly defining roles of key personnel. Key personnel we suggest for the Consortium are italicized below.

Overarching Consortium Expectations

• Identify a Consortium Management Team to advise and provide guidance in the implementation and evaluation of the Consortium, using partners’ feedback.

• Engage partners in the field to address challenges in implementation strategies and emerging issues, to include national, state, and local level perspectives, and lived experience from diverse and underrepresented populations.