MCHB HRSA-24-047 (U7A) State MHI_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Maternal and Child Health Bureau

Division of Healthy Start and Perinatal

State Maternal Health Innovation Funding Opportunity Number: HRSA-24-047

Funding Opportunity Type(s): Continuing Continuation, New

Assistance Listings Number: 93.110

Application Due Date: April 2, 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: December 15, 2024

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

HRSA-24-047 SMHI 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 Title: State Maternal Health Innovation

Funding Opportunity Number: HRSA-24-047

Assistance Listing Number: 93.110

Due Date for Applications: April 2, 2024

Purpose: The purpose of the State Maternal Health Innovation program is to reduce maternal mortality and severe maternal morbidity (SMM)1 by:

• Improving access to care that is comprehensive, high-quality, appropriate, and on-going throughout the preconception, prenatal, labor and delivery, and postpartum periods;

• Enhancing state maternal health surveillance and data capacity; and

• Identifying and implementing innovative interventions to improve outcomes for populations disproportionately impacted by maternal mortality and SMM.

Program Objective(s): • By September 29, 2025 (Project Year 1), each recipient will convene their Maternal Health Task Force (MHTF) and develop a draft Five-

1 American College of Obstetricians and Gynecologists (ACOG). Severe maternal morbidity includes unintended outcomes of the process of labor and delivery that result in significant short-term or long-term consequences to a woman’s health. (Severe Maternal Morbidity: Screening and Review | ACOG).

Accessed 7/27/2023.

https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pd f&isForDownload=False https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2016/09/severe-maternal-morbidity-screening-and-review

HRSA-24-047 SMHI ii

Year Maternal Health Strategic Plan (MHSP) to improve maternal health.

• By September 29, 2025 (Year 1), award recipients will identify core measures, including innovations to assess and report on program activities, including innovations, throughout the period of performance. This will take place in collaboration with HRSA.

• By September 29, 2026 (Year 2), each recipient and their established MHTF will submit a final

MHSP.

• By September 29, 2029 (Year 5), each recipient will increase the number of community members from populations with the highest rates of maternal mortality and severe maternal morbidity that participate on the state's Maternal Health Task Force and in the implementation of the MHSP activities.

• Recipients will release an annual public report each year of the performance period about maternal health topics relevant to the state.

• By September 29, 2029 (Year 5), identify and share the innovations with potential for replication, scale-up, and sustainability to improve maternal health.

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

• Public or private

• Community-based

Tribal (governments, organizations2

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

2 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-24-047 SMHI iii

Anticipated FY 2024 Total Available Funding:

$18,000,000

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 are not appropriated.

Estimated Number and Type of Award(s):

Up to 18 new cooperative agreement(s)

Estimated Annual Award Amount:

Up to $2,000,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: September 30, 2024 through September 29, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

Ernsley Charles Grants Management Specialist Division of Grants Management Operations, OFAM Email: Echarles@hrsa.gov

Program issues or technical assistance:

Sarah Meyerholz, MPH Maternal and Women’s Health Branch Division of Healthy Start and Perinatal Services Attn: State Maternal Health Innovation Program Maternal and Child Health Bureau Health Resources and Services Administration Email: wellwomancare@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:Echarles@hrsa.gov mailto:wellwomancare@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

HRSA-24-047 SMHI iv

Technical Assistance

We have scheduled the following webinar:

Monday, January 15, 2:00 to 4:00 p.m. ET

Weblink:

https://hrsa-gov.zoomgov.com/j/1608150762?pwd=WFlNSVlzVmpEWU1zZnFrQ2Rwc3ZHZz09

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

o Call-In Number (Toll-Free):

o 1 833 568 8864

Meeting ID: 160 815 0762

We will record the webinar and Frequently Asked Questions on our website:

https://www.hrsa.gov/grants/find-funding/.

https://hrsa-gov.zoomgov.com/j/1608150762?pwd=WFlNSVlzVmpEWU1zZnFrQ2Rwc3ZHZz09 https://hrsa-gov.zoomgov.com/j/1608150762?pwd=WFlNSVlzVmpEWU1zZnFrQ2Rwc3ZHZz09 https://www.hrsa.gov/grants/find-funding/

HRSA-24-047 SMHI 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: ADDITIONAL INFORMATION FOR APPLICANTS

1. QUALITY SERVICES:

2. DATA CAPACITY:

3. HEALTH DISPARITIES:

APPENDIX C: GLOSSARY OF KEY TERMS

HRSA-24-047 SMHI 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the State Maternal Health Innovation (State MHI) program. The purpose of the State MHI program is to reduce maternal mortality and severe maternal morbidity (SMM)3 by:

• Improving access to care that is comprehensive, high-quality, appropriate, and on-going throughout the preconception, prenatal, labor and delivery, and postpartum periods;

• Enhancing state maternal health surveillance and data capacity; and

• Identifying and implementing innovative interventions to improve outcomes for populations disproportionately impacted by maternal mortality and SMM.

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

• By September 29, 2025 (Project Year 1), each recipient will develop a draft 5- Year Maternal Health Strategic Plan (MHSP) to improve maternal health.

• By September 29, 2025 (Year 1), award recipients will identify core measures to assess and report on program activities, including innovations, throughout the period of performance. This will take place in collaboration with HRSA.

• By September 29, 2026 (Year 2), each recipient and their established MHTF will submit a final MHSP.

• By September 29, 2029 (Year 5), each recipient will increase the number of community members from populations with the highest rates of maternal mortality and severe maternal morbidity that participate on the state's Maternal Health Task Force and in the implementation of the MHSP activities.

• Recipients will release a public Maternal Health Annual Report each year of the period of performance about maternal health topics relevant to the state.

• By September 29, 2029 (Year 5), identify and share the innovations with potential for replication, scale-up, and sustainability to improve maternal health.

For more details, see Program Requirements and Expectations.

2. Background

The State Maternal Health Innovation program is authorized by 42 U.S.C. § 701(a)(2)

3 American College of Obstetricians and Gynecologists (ACOG). Severe maternal morbidity includes unintended outcomes of the process of labor and delivery that result in significant short-term or long-term consequences to a woman’s health. (Severe Maternal Morbidity: Screening and Review | ACOG).

Accessed 7/27/2023.

https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pd f&isForDownload=False https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2016/09/severe-maternal-morbidity-screening-and-review

HRSA-24-047 SMHI 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 MCHB mission to improve the health and well-being of America’s mothers, children, and families.

Maternal Mortality and Severe Maternal Morbidity

Approximately 3.6 million women give birth in the United States each year.4 Despite advances in medical care and investments in improving access to care, rates of maternal mortality and SMM are high and have not improved. Over 800 women die each year in the United States from pregnancy-related causes.5 More than 25,000 women experience unintended outcomes of labor and delivery that result in significant short- or long-term consequences to their health.6 Significant disparities exist in maternal mortality, SMM, and other adverse outcomes, which vary by socio-economic factors such as race, ethnicity, age, geography, and income.7 8

History of State Maternal Health Innovation

We launched the State MHI program on September 30, 2019, with 5 year cooperative agreements in nine states. We provided funding to an additional nine states in 2022, and 17 more states in 2023. Altogether, there are now 35 states involved in implementing maternal health innovations. Each of the states have met short- and intermediate-term goals to improve their ability to prevent and reduce maternal mortality and SMM, and to enhance maternal health. This has included efforts to address diverse maternal health needs and issues through the use of data and evidence.

Maternal Health Training and Resource Center

Formerly the Maternal Health Learning Innovation Center (MHLIC), MHTRC serves as the direct technical assistance provider for the current State MHI award recipients and other state-focused maternal health initiatives. The goal of the MHTRC is to foster collaboration and learning amongst a wide range of maternal health stakeholders and the general public to accelerate evidence-informed maternal health interventions.

4 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 5 Hoyert DL. Maternal Mortality Rates in the United States, 2021. March 2023. Available at:

https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/E-stat-Maternal-Mortality-Rates-2022.pdf.

Accessed 7/26/2023.

6 HRSA Federally Available Data (FAD) Resource Document. Release Version July 18, 2023. Available at https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pd f&isForDownload=False Accessed 7/26/2023.

7 Hoyert 2023.

8 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://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/E-stat-Maternal-Mortality-Rates-2022.pdf https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pdf&isForDownload=False https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pdf&isForDownload=False

HRSA-24-047 SMHI 3

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:

• Supporting partnership and communication with federally funded maternal health programs and other relevant federal entities to ensure successful completion of tasks and activities outlined in the approved scope of the cooperative agreement.

• Continuously assessing the establishment and execution of activities, procedures, measures, and tools aimed at achieving the cooperative agreement's goals.

• Evaluating and offering insights on written documents, including materials and information related to cooperative agreement activities, before they are published or publicly shared.

• Collaborating with the award recipient to share project findings, best practices, and insights gained from the project with the wider audience.

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

• Completing activities proposed in response to the Program Requirements and Expectations section of this notice of funding opportunity.

• Giving the federal project officer the chance to review and discuss any materials produced like publications and audiovisuals, as well as planned meetings, within this cooperative agreement. This review process starts during concept development and includes checking drafts and final products.

• Taking part in technical assistance and capacity building events organized by the designated Maternal Health Training and Resource Center provider(s). This can involve joining an annual meeting held by the center or collaborating with other federal agencies and awardees.

• Participating in face-to-face meetings, virtual meetings, and conference calls with HRSA during the period of performance This includes monthly written reports and at least one in-person site visit to showcase innovations.

HRSA-24-047 SMHI 4

• Supporting at least one in-person/hybrid gathering of the MHTF during the project duration.

• Coordinating with the federal project officer to plan meetings related to the cooperative agreement's scope where the project officer's presence would be fitting, as determined by the project officer.

• Following HRSA's guidelines for acknowledgment and disclaimers on all products made using HRSA award funds, following Section 2.2 of the Application Guide (Acknowledgement of Federal Funding).

• Collaborating with HRSA on ongoing review of activities, procedures, budget items, information/publications prior to dissemination.

• Playing a leading role in collecting and analyzing data.

• Taking part in evaluation activities led by the HRSA-appointed evaluation contractor.

• Submitting all administrative data and performance measure reports as specified by HRSA and within set timelines.

• Collaborating with the Maternal and Child Health Title V Director of their state and Maternal Mortality Review Committee (MMRC) or any other state-focused entity responsible for tracking maternal health data, if applicable.

• Remaining flexible and collaborating with HRSA to adjust responsibilities as necessary.

2. Summary of Funding

We estimate approximately $18,000,000 to be available each year to fund up to 18 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

HRSA-24-047 SMHI 5

Please reference Table 6 in Births: Final Data for 2021 (National Vital Statistics Reports, Volume 72, No. 1), which provides the number of births by state for 2021 in your application.9

The period of performance is September 30, 2024 through September 29, 2029 (5 years).

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

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

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, non-profit

• Community-based

• Tribal (governments, organizations)10

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

9 National Vital Statistics Reports Volume 72, Number 1, January 31, 2023 (cdc.gov) 10 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 https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf

HRSA-24-047 SMHI 6

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

Existing award recipients under the FY22 and FY23 State MHI program funding opportunities 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 period of performance end date.

In order to maximize resources and minimize duplication of efforts, only one project will be funded per state under this notice.

Multiple Applications

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

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-24-047 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will 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-24-047 SMHI 7

Application Page Limit The total number of pages that count toward the page limit shall be no more than 50 pages when we print them. We 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 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.vi Attachments.

If you use an OMB-approved form that is not in the HRSA-24-047 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-047 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals11 (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.12

• If you cannot certify this, you must include an explanation in Attachment 12-15:

Other Relevant Documents.

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

Program Requirements and Expectations For this funding opportunity, you should propose projects to strengthen state-level capacity in achieving the objectives through the following program requirements and expectations. If the applicant is not a state public health agency, a letter of agreement to document the state public health agency’s relationship with the applicant as well as plans for participation and collaboration should be included as Attachment 4.

1. Establish and/or Adapt a State-Focused Maternal Health Task Force (MHTF)

11 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).

12 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

HRSA-24-047 SMHI 8

Every program should set up a statewide task force or adapt an existing one to become a Maternal Health Task Force (MHTF). The purpose of the MHTF is to bring together maternal health stakeholders and serve as the central coordinating body for advancing maternal health within the state. The MHTF will examine maternal health data specific to the state and then create and put into action innovative strategies backed by evidence and data. These strategies will address gaps and needs in maternal health identified through a strategic planning process. They will consider the underlying factors affecting maternal health disparities.

The MHTF's membership should be comprised of, but not limited to, state and local public health experts, such as representatives from the State Department of Health, State Title V Maternal and Child Health (MCH) Program, State Medicaid Program, and State Maternal Infant and Early Childhood Home Visiting Program. Membership should also include liaisons from the state's MMRC; individuals who have experienced pregnancy and the postpartum period; clinical providers like midwives and doulas;

hospitals; representatives from community organizations focusing on reducing maternal mortality; tribes or tribal organizations; insurers; and representatives from different sectors such as transportation, housing, and corrections. The leadership and membership of the task force should reflect the communities impacted in the state.

The MHTF can be part of an existing task force concentrated on enhancing maternal health; it might need adjustments or expansions to accommodate the groups listed in this funding opportunity. If a new task force is created, it should be carefully aligned with existing state maternal health entities and should not duplicate efforts. The award recipient is responsible for managing the MHTF programmatically and administratively.

The award recipient is expected to ensure that the MHTF participates in the creation of a Maternal Health Strategic Plan (MHSP) and carries out the activities outlined in its action plan, as described below.

Each Maternal Health Task Force is expected to:

• Conduct an initial evaluation of maternal care and coverage in the state.

Examples of assessment topics include: distribution of active OB/GYNs, midwives, doulas, and family medicine providers offering maternal care in the state; an overview of the types of payors and the prenatal, birth, and postnatal services covered; and distribution and diversity of birthing facilities statewide.

• Based on findings and recommendations from the state MMRC and other maternal health reports and publications (such as the Title V needs assessment) and an analysis of available data, identify state-specific gaps that impact maternal health outcomes. Examples of significant gaps include:

insufficient state-level monitoring of maternal health; lack of access to quality prenatal and maternity care in areas with limited medical resources; and inadequate access to behavioral health professionals.

• Support State MHI staff in the development and implementation of the Maternal Health Strategic Plan (MHSP). This plan should align with (1) the

HRSA-24-047 SMHI 9

MMRC findings and recommendations (if applicable); and (2) the most recent comprehensive 5-year Title V Needs Assessment and State Action Plan and Maternal Infant and Early Childhood Home Visiting (MIECHV) Needs Assessment of the state. The strategic plan should outline a vision, strategic objectives, measurable goals, and proposed innovations to enhance outcomes for those populations disproportionately impacted by maternal mortality and SMM.

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

o If a state lacks adequate maternal health data to pinpoint innovations to improve outcomes for populations disproportionately impacted by maternal mortality and SMM, an early focus of the strategic plan should be on enhancing maternal health data quality and capabilities.

o The strategic plan should evolve throughout the project as additional data are collected and analyzed and as lessons are learned from implementation of innovative approaches.

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

• Task Forces should report on how strategies/innovations are informed by their MMRC and other maternal health data (SMM data, Title V measures, other maternal health indicators they’ve explored, etc.).

• 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.

• Your project’s MHTF should meet in person at least once (1) during the period of performance.

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. Successful recipients are expected to identify and collaborate with a multidisciplinary state-focused MMRC and other state-focused initiatives 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 and recommendations from MMRCs and other maternal health initiatives to identify and implement activities and improve systems of prenatal and maternity care services, particularly for populations disproportionately impacted by maternal mortality and SMM.

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

1. Implement recommendations from a state-focused MMRC or other state-focused mechanism that conducts surveillance on maternal health data. Please note that

HRSA-24-047 SMHI 10

these funds are not to be used solely to support MMRCs, but can be used for implementation of recommendations from the state MMRC or a similar mechanism that conducts maternal health data surveillance.

2. Align strategies and data collection with the Title V State Action Plan Maternal/Women’s Health, Infant Health, Adolescent Health, and/or Cross-cutting Domains. Applicants are expected to collaborate with Title V (where applicable) in addressing data collection for proposed National Performance Measure (NPM) 1: Percent of women who attended a postpartum checkup within 12 weeks after giving birth.

This alignment may also include proposed measures such as:

a. NPM 2: Percent of women screened for depression or anxiety following a recent live birth.

b. NPM 3: Percent of women using a most or moderately effective contraceptive following a recent live birth.

c. NPM 4: Percent of women with a recent live birth who experienced racial/ethnic discrimination while getting healthcare during pregnancy, delivery, or at postpartum care.

d. NPM 8.1: Percent of women with a recent live birth who experienced housing instability in the 12 months before a recent live birth.

3. Improve maternal health data quality and timeliness:

a. Assure access to and assessment of indicators of state/jurisdictional data on pregnancy-related deaths, including SMM, and the disparities in these indicators.

b. Disaggregate maternal health indicators and outcomes by maternal race/ethnicity, age, level of education, income, health insurance coverage, and geographic location (urban/rural).

c. Examine additional indicators, such as social determinants of health, and analyze the data in relation to maternal health.

d. Improve data linkages to support surveillance activities.

If a state lacks adequate maternal health data to pinpoint innovations to improve outcomes for populations disproportionately impacted by maternal mortality and SMM, an early focus of the strategic plan should be on enhancing maternal health data quality and capabilities.

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

HRSA-24-047 SMHI 11

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 focused on addressing needs at the individual, interpersonal, community, and societal levels, particularly for those populations disproportionately impacted by maternal mortality and SMM. Award recipients are expected to implement innovative strategies in one or more of the following areas:

1. Quality Services

2. Data Capacity; and/or

3. Health disparities

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

4. Performance Measurement, Program Evaluation, and Continuous Quality Improvement (CQI): Recipients will be expected to conduct the following performance measurement, program evaluation, and/or CQI activities:

• Performance Measurement: Measure and track program performance on key activities and program objectives.

o This includes Discretionary Grants Information System (DGIS) measures noted in the Reporting section.

• Program Evaluation: Recipients are expected to conduct a recipient-led evaluation and participate in a HRSA-contracted evaluation.

o Recipient-led evaluations: These evaluations may be conducted by the recipient(s) or conducted by an external organization and led by the recipient. Expectations for the evaluation include:

Create a plan to evaluate program performance that contributes to ongoing quality improvement. This evaluation should keep an eye on the ongoing processes and the progress made toward the project's goals and objectives.

Gather the resources you'll use (like organizational information, partners, key staff, budget, and other resources), consider the important steps in your processes, and the anticipated results of the activities that will be funded.

HRSA-24-047 SMHI 12

Detail the systems and methods your organization will employ to manage performance, which will involve effectively monitoring performance outcomes.

Gather and handle data (with skilled staff and data management software, for instance) in a way that allows accurate and prompt reporting of performance outcomes.

Collect, analyze, and keep track of data to measure both the progress and impact of your activities, particularly for populations disproportionately impacted by maternal mortality and SMM.

Consider how these data will be used to shape program development and guide the implementation of activities.

Examine any potential challenges that might arise when carrying out the program performance evaluation and include strategies for tackling those challenges in your evaluation plan.

o HRSA-contracted evaluations: Award recipient will also be expected to share these recipient-led evaluation findings with a HRSA-contracted evaluator.

Program-Specific Instructions Include application requirements and instructions from Section 4 of the Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you’ll find in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the Application Guide.

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: NEED

Organizational Information Criterion 5: RESOURCES/CAPABILITIES

Needs Assessment Criterion 1: NEED

Approach Criterion 2: RESPONSE

HRSA-24-047 SMHI 13

Narrative Section Review Criteria

Work Plan Criterion 2: RESPONSE and Criterion 4: IMPACT

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES and

Criterion 5: RESOURCES/CAPABILITIES

Budget Narrative Criterion 6: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

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.

Organizational Information -- Corresponds to Section V’s Review Criterion #5 Resources/Capabilities

• Succinctly describe your organization’s current mission and structure, the scope of current activities, and how these elements contribute to your organization’s ability to conduct the program activities and meet program expectations. Include a project organizational chart as Attachment 5.

• 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 full-time equivalents (FTEs) fulfilling the role, and roles and responsibilities of each position.

• Provide a list of proposed partners for the MHTF and identify partner roles and responsibilities for program implementation, including community representation from those populations with the highest rates of pregnancy-related mortality and SMM. Include letters of agreement (e.g., State Title V MCH Agency, MMRC, Hospital Association, etc.)

HRSA-24-047 SMHI 14

and/or descriptions of proposed/existing project-specific contracts in Attachment 4.

• 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.

• Describe the organization’s relationships to the State Title V MCH Block Grant Program. 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, MIECHV, State Perinatal Quality Collaborative, Federally Qualified Health Centers, state hospital association, professional organizations) with which you plan to partner, collaborate, coordinate efforts, or receive consultative services from, while conducting project activities.

• 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.

Needs Assessment -- Corresponds to Section V’s Review Criterion #1 Need Outline the maternal health needs of the state. Use and cite demographic data whenever possible to support the information provided.

• Identify and describe maternal health indicators at the state-level which may include breakdowns by race, age, income, etc. for the total number of live births; total number of pregnancy-related deaths; pregnancy-related mortality rate (per 100,000 live births); rate of SMM (per 10,000 delivery hospitalizations); 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). Use the most recent data available and identify the year(s) of data used.

• Discuss what factors contribute to maternal mortality and SMM, and any relevant barriers in the state that the project hopes to overcome.

• Describe the geographic and demographic disparities in maternal health indicators and the social determinants of health (SDOH) within the state (e.g., race/ethnicity, rurality/urbanicity, socioeconomic status, housing, education, etc.).

HRSA-24-047 SMHI 15

• Describe the maternal health services landscape in the state with respect to access (distribution, number and types of birthing facilities), distribution of providers, type of providers, and payer mix.

• Describe the status of any ongoing state-led initiatives to improve maternal health and how the proposed project connects with these initiatives. Include Title V and the State MMRC in the description. If applicable, also include activities to improve maternal health data through SSDI, the State Perinatal Quality Collaborative, and other state-focused initiatives to collect, analyze, and report maternal mortality and SMM data.

• Describe the current capacity to collect, report, and analyze high quality and timely data. Describe the state’s current capacity to collect and report data on race, ethnicity, age, level of education, insurance coverage, geographic location, and other social determinants to assess the impact of the program on improving outcomes for populations disproportionately impacted by maternal mortality and SMM. If applicable, identify gaps in data related to disparities that your proposed program will address.

This section will help reviewers understand whom you will serve with the proposed project.

Approach -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact

• 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.

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

• Outline the approach for establishing the state-focused MHTF or for adapting an existing statewide task force to serve as the state-focused MHTF. Include in the approach the MHTF membership and describe how the task force will reflect the impacted communities within the state, its partnership goals, and how the MHTF will engage and support implementation of project activities.

• If the work of the MHTF requires approval by a state-level government entity, include a letter of agreement from the entity that outlines how they will serve as an equal partner in implementing cooperative agreement requirements. This letter should be included as Attachment 4.

HRSA-24-047 SMHI 16

• Outline the process for the development of the Maternal Health Strategic Plan (MHSP) and describe how the MHTF will be involved in implementing strategies.

Program Planning

• Describe plans to provide leadership as a convener/collaborator in advancing state maternal mortality efforts. Describe plans to incorporate the lived experience and perspectives of those populations with the highest rates of pregnancy-related mortality and SMM. Include other relevant factors (e.g., housing insecurity, employment status, rurality/urbanicity, etc.) as appropriate.

• Describe plans to include the input of pregnant and postpartum individuals with lived experiences (such as those populations disproportionately impacted by maternal mortality and SMM) in program development and implementation.

• Describe the various strategies and activities that the state will implement to achieve project goals. Provide Specific, Measurable, Achievable, Realistic, Time-bound, Inclusive, and Equitable (SMARTIE) objectives for each proposed project goal, as applicable. Include any innovative methods that you will use to address the stated needs.

Program Implementation & Collaboration

• 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.

• Describe plans to implement recommendations from the MMRC or other state-focused mechanism that conducts surveillance on maternal health data to support data-driven innovations.

• Describe plans to collaborate with the SSDI award recipient in your state to build data capacity and infrastructure, as applicable.

• Describe the plans and activities that will be implemented to foster collaborative learning with traditional and non-traditional partners, including tribes/tribal organizations, and cross-sector agencies such as employment, housing, and corrections.

Maternal Health Data Capacity

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

HRSA-24-047 SMHI 17

• Describe plans to assure access to and usage of state/jurisdictional data on pregnancy-related deaths, SMM, and other maternal health-related indicators.

• Describe plans to improve quality and timeliness of maternal health data, including improving or establishing data linkages to support surveillance activities.

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. We recommend that you submit a work plan in table format as Attachment 1 and include all of the 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

• 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.

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

• 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

HRSA-24-047 SMHI 18

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.

• Describe the strategy to collect, analyze, and monitor data to measure process and impact of innovations, particularly for the populations disproportionately impacted by maternal mortality and SMM.

• Explain how the data will be used to inform program development and implementation of program activities.

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

iii. Budget

The Application Guide directions may differ from those on Grants.gov.

Follow the instructions in Section 4.1.iv Budget of the Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs used for the HRSA activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include MOE, if applicable).

Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR § 75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), Division H, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural…