MODIFIED 1.12.22_FORHP HRSA-22-057 (GA1) RCORP-I Final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy Rural Strategic Initiatives Division

Rural Communities Opioid Response Program-Implementation

Funding Opportunity Number: HRSA-22-057 Funding Opportunity Types: New and Competing Continuation

Assistance Listings (CFDA) Number: 93.912

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: January 18, 2022

MODIFIED on January 12, 2022: Extended Application Due Date

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

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: October 15, 2021

Sabrina Hope Frost Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 945-5131 Email: ruralopioidresponse@hrsa.gov for program-specific questions

Please contact the Grants Management Specialist on page 38 of the NOFO for budget-related questions (e.g., allowable costs, SF-424 A form, etc.).

Authority: 42 U.S.C. 912(b)(5) (§ 711(b)(5) of the Social Security Act) mailto:ruralopioidresponse@hrsa.gov

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508 COMPLIANCE DISCLAIMER

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

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2022 Rural Communities Opioid Response Program-Implementation (RCORP-Implementation). RCORP is a multi-year initiative by HRSA aimed at reducing the morbidity and mortality of substance use disorder (SUD), including opioid use disorder (OUD), in high-risk rural communities. This funding opportunity, RCORP- Implementation, will advance RCORP’s overall goal by strengthening and expanding SUD/OUD prevention, treatment, and recovery services to enhance rural residents’ ability to access treatment and move towards recovery.

Funding Opportunity Title: Rural Communities Opioid Response

Program-Implementation Funding Opportunity Number: HRSA-22-057 Due Date for Applications: January 18, 2022 Anticipated Total Annual Available FY 2022 Funding:

Approximately $50,000,000, subject to the availability of appropriated funds.

Estimated Number and Type of Awards: Approximately 50 grants Estimated Award Amount: Up to $1,000,000 for the three-year period of performance. Award recipients will receive the full award amount in the first year of the period of performance and are required to allocate it across all three years.

Cost Sharing/Match Required: No Period of Performance: September 1, 2022 through August 31, 2025 (3 years) Eligible Applicants: All domestic public and private entities, nonprofit and for-profit, are eligible to apply. Domestic faith-based and community-based organizations, tribes, and tribal organizations and organizations based in the territories and freely associated states are also eligible to apply.

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

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, November 10, 2021 Time: 12:30 – 2:00 p.m. ET Call-In Number: 1-833-568-8864 Meeting ID: 160 852 4742 Passcode: 23233962 Weblink: https://hrsa-gov.zoomgov.com/j/1608524742?pwd=UFJvcGs5bHFiYXRkcGRleFd6REpnZz09

The webinar will be recorded. Please email ruralopioidresponse@hrsa.gov for a link to the recording.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1608524742?pwd=UFJvcGs5bHFiYXRkcGRleFd6REpnZz09 https://hrsa-gov.zoomgov.com/j/1608524742?pwd=UFJvcGs5bHFiYXRkcGRleFd6REpnZz09 mailto:ruralopioidresponse@hrsa.gov

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER

TRANSITION TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT

(SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORM ATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) AND

THE NATIONAL HEALTH SERVICE CORPS (NHSC)

APPENDIX B: RESOURCES FOR APPLICANTS

APPENDIX C: POTENTIAL CONSORTIUM MEMBERS

APPENDIX D: ALLOWABLE ADDITIONAL ACTIVITIES (OPTIONAL)

APPENDIX E: APPLICATION COMPLETENESS CHECKLIST

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I. Program Funding Opportunity Description

1. Purpose

The Rural Communities Opioid Response Program (RCORP) is a multi-year initiative by the Health Resources and Services Administration (HRSA) aimed at reducing the morbidity and mortality of substance use disorder (SUD), including opioid use disorder (OUD), in high risk rural communities. This notice announces the opportunity to apply for funding under RCORP-Implementation. This funding opportunity, RCORP- Implementation, will advance RCORP’s overall goal by strengthening and expanding SUD/OUD prevention, treatment, and recovery services to enhance rural residents’ ability to access treatment and move towards recovery.

Given the complex and multifaceted nature of SUD/OUD, as well as the need to secure community buy-in and generate adequate patient volume to sustain services, HRSA requires that applicants be part of broad, multi-sectoral consortia. HRSA expects that consortia funded by RCORP-Implementation will sustain the SUD/OUD-related services in rural areas made possible by this funding opportunity both during and beyond the period of performance.

The target population for the award is: 1) individuals who are at risk for, have been diagnosed with, and/or are in treatment and/or recovery for OUD; 2) their families and/or caregivers; and 3) other community members1 who reside in HRSA-designated rural areas, as defined by the Rural Health Grants Eligibility Analyzer. In addition to this target population, applicants are encouraged to give special consideration to rural populations that have historically suffered from poorer health outcomes or health disparities, as compared to the rest of the rural population.

The primary focus of the RCORP-Implementation award program is OUD. However, recognizing that many individuals with OUD use multiple substance and/or have other co-occurring conditions, consortia may also use RCORP-Implementation support to help address other SUD-related needs of the target population of individuals and families affected by OUD. Applicants should link any additional activities they propose to the needs of their target population and service area. Please note that no competitive advantage, funding priority, or preference is associated with proposing activities beyond the core/required activities outlined in the Program-Specific Instructions section of this

NOFO.

2. Background

RCORP-Implementation is authorized by Section 711(b)(5) of the Social Security Act (42 U.S.C. 912(b)(5)).

The Rural Communities Opioid Response Program is administered through HRSA’s Federal Office of Rural Health Policy, which is charged with supporting activities related to improving health care in rural areas.

1Applicants are encouraged to include individuals in the community who are involved in improving health care in rural areas.

https://www.hrsa.gov/rural-health/rcorp https://data.hrsa.gov/tools/rural-health

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In 2017, HHS declared the opioid crisis a nationwide public health emergency. Rural providers and communities in particular face a number of challenges in providing and accessing SUD/OUD services. In July 2020, nearly two-thirds of all rural counties (63.1%) had at least one clinician with a Drug Enforcement Administration (DEA) waiver but more than half of small and remote rural counties lacked one.2 In addition to workforce shortages, rural communities face barriers such as stigma, transportation, and costs associated with setting up MAT and other SUD/OUD services.3

Rural residents who use opioids are more likely than their urban counterparts to have socioeconomic vulnerabilities, including limited educational attainment, poor health status, lack of health insurance, and low income,4 which may further limit their abilities to access treatment. The opioid epidemic has also led to an increase in people who inject drugs (PWID), which in turn has increased the risk of transmission of viruses such as human immunodeficiency virus (HIV) and hepatitis B and C viruses (HBV and HCV) through shared equipment. Rural communities are particularly vulnerable to outbreaks of HIV and HCV among uninfected PWID.5

Recent Centers for Disease Control and Prevention data suggest that synthetic opioids are increasingly playing a role in psychostimulant-involved deaths. Drug overdose deaths involving psychostimulants with abuse potential, including methamphetamine, increased by over a third in rural communities between 2016 and 2017.6

The COVID-19 pandemic forced rural communities to adapt and stretch limited resources and exacerbated the opioid crisis. Over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recent provisional data from CDC.7 From 1999 through 2019, the rate of drug overdose deaths increased from 4.0 per 100,000 to 19.6 in rural counties.8

2 Andrilla CHA, Patterson DG. Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder. J Rural Health. 2021; 1-6. https://doi.org/10.1111/jrh.12569 3 See, e.g., Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care:

Environmental Scan Volume 1, AHRQ, https://integrationacademy.ahrq.gov/sites/default/files/mat_for_oud_environmental_scan_volume_1_1.pdf 4Lenardson, Jennifer et al (2016), “Rural Opioid Abuse: Prevalence and User Characteristics,” Maine Rural Health Research Center, http://muskie.usm.maine.edu/Publications/rural/Rural-Opioid-Abuse.pdf 5 Van Handel MM et al, “County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States,” J Acquir Immune Defic Syndr (2016):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479631/; See also Centers for Disease Control and Prevention, “Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs,” March 2018, https://www.cdc.gov/hiv/pdf/programresources/guidance/cluster-outbreak/cdc-hiv-hcv-pwid-guide.pdf.

6 See, e.g., Kariisa et al (2019), “Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential—United States, 2003-2017,” CDC Morbidity and Mortality Weekly Report, https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6817a3-H.pdf.

7 Center for Disease Control. (December 2020) Expanded prevention efforts needed [Press release].

Retrieved from https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html 8 Hedegaard H, Spencer MR. Urban–rural differences in drug overdose death rates, 1999–2019. NCHS Data Brief, no 403.

Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi. org/10.15620/cdc:102891.

https://doi.org/10.1111/jrh.12569 https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

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RCORP supports and encourages projects that address the needs of a wide range of population groups, including, but not limited to, low-income populations, the elderly, pregnant women, youth, adolescents, ethnic and racial minorities, people/persons experiencing homelessness, and individuals with special health care needs.

Addressing issues of equity should include an understanding of intersectionality and how multiple forms of discrimination impact individuals’ lived experiences. Individuals and communities often belong to more than one group that has been historically underserved, marginalized, or adversely affected by persistent poverty and inequality.

Individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages, including in their access to needed services.

As part of HRSA’s overall strategy for addressing SUD/OUD in rural communities, in FY 2022, HRSA will provide funds for the National Health Service Corps (NHSC) Rural Community Loan Repayment Program (LRP) under separate funding opportunity to award eligible providers (Allopathic/Osteopathic Physicians, Physician Assistants, Psychiatrists, Nurse Practitioners, Certified Nurse-Midwives, Psychiatric Nurse Specialists, Health Service Psychologists, Licensed Clinical Social Workers, Marriage and Family Therapists, Licensed Professional Counselors, SUD counselors, Clinical Pharmacists, Registered Nurses and Nurse Anesthetists) who are working at a rural NHSC-approved SUD treatment facility. Clinicians working at NHSC-approved RCORP consortium member site will receive funding priority. RCORP-Implementation applicants are encouraged to leverage the NHSC Rural Community LRP to support the recruitment and retention of eligible providers from the SUD workforce.

• For additional information on the Rural Community LRP and Sites, see Appendix A. For a list of current rural NHSC-approved SUD facilities, visit HRSA’s Health Workforce Connector.

• To learn how to become an NHSC site, visit the NHSC website.

In 2019, the U.S. Department of Health and Human Services (HHS) Rural Health Task Force developed the “Healthy Rural Hometown Initiative” (HRHI). The HRHI is an effort that seeks to address the underlying factors that are driving growing rural health disparities related to the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke).

RCORP-Implementation supports the HRHI initiative by aiming to reduce mortality from unintentional injury resulting from drug overdose. While applicants and award recipients to RCORP-Implementation do not need to explicitly link their activities to the HRHI, HRSA may plan to use the performance data submitted by RCORP-Implementation award recipients to demonstrate how RCORP-Implementation supports the overall goal of the HRHI. For more information on the Healthy Rural Hometown Initiative, see page 29 of the HHS Rural Action Plan.

For information on other HRSA-supported SUD/OUD funding opportunities, resources, technical assistance, and training, visit https://www.hrsa.gov/opioids. For information on other federal SUD/OUD resources, please see Appendix B.

https://connector.hrsa.gov/connector/ https://connector.hrsa.gov/connector/ https://nhsc.hrsa.gov/ https://www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf https://www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf https://www.hrsa.gov/opioids

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II. Award Information

1. Type of Application and Award

Types of applications sought: New and Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $50,000,000 to be available to fund approximately 50 recipients over a three-year period of performance. The actual amount available will not be determined until the enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $1,000,000 total cost (includes both direct and indirect, facilities and administrative costs). This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is September 1, 2022 through August 31, 2025 (three years). Award recipients will receive the full award amount in the first year of the three-year period of performance, and must allocate the funding across each of the three years. Additionally, recipients must submit a budget and budget narrative for each of the three years of the period of performance. While you must distribute the funding across each of the three years, the budget does not need to be evenly split across the three-year period of performance, and can vary based on your community’s needs.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

Applicant Organization Specifications

Eligible applicants include all domestic public or private, non-profit or for-profit entities, including faith-based and community-based organizations, tribes, and tribal organizations. In addition to the 50 U.S. states, organizations in the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated State of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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The applicant organization may be located in an urban or rural area and should have the staffing and infrastructure necessary to oversee program activities, serve as the fiscal agent for the award, and ensure that local control for the award is vested in the targeted rural communities.

Service Delivery Specifications

All planned activities supported by this program must exclusively target and be located in HRSA-designated rural counties and rural census tracts, as defined by the HRSA Rural Health Grants Eligibility Analyzer. Within partially rural counties, only HRSA-designated rural census tracts are eligible to receive activities and services supported by this award.

NOTE: Beginning with FY 2022 grants, FORHP has modified its list of areas eligible for Rural Health funding. No areas were removed from the prior listing but 295 outlying Metro counties are now considered fully rural. Applicants can check the Rural Health Grants Eligibility Analyzer or the List of Rural Census Tracts document to determine eligibility status of an address or county.

While all service delivery sites supporting RCORP-Implementation projects must be exclusively located in HRSA-designated rural areas, given the shortage of service delivery sites in HRSA-designated rural areas, some exceptions apply in the specific instances listed below. In order to qualify for one of these exceptions, the applicant must establish that the non-rural service delivery site is a primary service provider for the target rural service area and that the delivery site will directly contribute to building health service delivery infrastructure within the target rural service area (see Attachment 9 for additional instructions on submitting required documentation for these exceptions).

• Critical Access Hospitals (CAHs) that are not located in HRSA-designated rural areas.

• Entities eligible to receive Small Rural Hospital Improvement (SHIP) funding and that are not located in HRSA-designated rural areas. Eligible entities under this exception include hospitals that are non-federal, short-term general acute care and that: (i) are located in a rural area as defined in 42 U.S.C. 1395ww(d) and (ii) have 49 available beds or less, as reported on the hospital’s most recently filed Medicare Cost Report.

• Entities that are located in urban areas of partially rural counties in their target service area if the service delivery site is located in an incorporated city, town, or village, or unincorporated census-designated place (CDP), with 49,999 or fewer people.

• Telehealth service delivery sites located in an urban facility, but exclusively serving patients in HRSA-designated rural areas https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/Content/Documents/tools/rural-health/forhpeligibleareas.pdf

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Consortium Specifications

HRSA requires that applicants be part of broad, multi-sectoral consortia comprised of the following:

• At least four or more separately owned entities, including the applicant organization. The entities should all have different EINs and have established working relationships. Tribal applicants may be eligible for an exception to the EIN requirement, as described in the Eligibility section.

• At least 50 percent, of members in each consortium must be located within HRSA-designated rural areas or census tracts, as defined by the HRSA Rural Eligibility Analyzer. Applicants must provide a single letter of commitment signed by all consortium members reflected in the proposed work plan. See Attachment 3 for additional information.

• Members from multiple sectors and/or disciplines that have a demonstrated history of collaborating to address SUD/OUD in a rural area. Applicants are encouraged to incorporate individuals and community sectors particularly affected by SUD/OUD, including health and social service organizations, employers, individuals in recovery, law enforcement and first responders, teachers and school systems, child welfare agencies, etc.

o Note while individuals may be included as consortium members, there must also be at least four separately owned entities/organizations to meet HRSA’s required consortium specifications. See Appendix C for a non-exhaustive list of potential consortium partners.

If awarded, recipients must notify consortium members who will be serving as subcontractors/subrecipients that they must be registered in SAM.

NOTE: HRSA is aware that tribes and tribal governments may have an established infrastructure without separation of services recognized by filing for EINs. In the case of tribes and tribal governments, only a single EIN located in a HRSA designated rural area is necessary for eligibility as long as the EIN is associated with an entity located in a HRSA-designated rural area. Tribes and tribal entities under the same tribal governance must still meet the consortium criteria of four or more entities committed to the proposed approach

FY 2020 and FY 2021 RCORP-Implementation Award Recipients and Consortium Members:

Applicants that are FY 2020 or FY 2021 RCORP-Implementation award recipients and/or Consortium Members are ONLY eligible to apply for this funding opportunity if they meet the following conditions:

1. Target Geographic Rural Service Area: The target geographic rural service area proposed in this application does not overlap at all with the one currently served by the consortium for the FY 20 or FY 21 RCORP-Implementation award and all proposed services are delivered in the new target rural service area. FY https://data.hrsa.gov/tools/rural-health

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2020 and FY 2021 RCORP-Implementation award recipients and/or consortium members should demonstrate they meet these conditions in Attachment 7; and

2. Consortium Membership: At least 50 percent of the consortium members proposed in this application are physically located in the new service area and are signatories to the letter of commitment (Attachment 3).

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

• Exceeds the ceiling amount;

• Fails to satisfy the deadline requirements referenced in Section IV.4; and/or

• Exceeds the page limit (80 pages).

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date as the final and only acceptable application.

NOTE: Organizations may not serve as the applicant organization on more than one FY 2022 RCORP-Implementation application. Only one application can be associated with an EIN.

• Exception to Multiple Submissions Policy: In general, multiple applications associated with the same EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the rural health care industry and the possibility that multiple organizations with the same EIN could be located in different rural service areas that have a need for SUD/OUD services.

Therefore, at HRSA’s discretion, separate applications associated with a single EIN may be considered for this funding opportunity if the applicants provide HRSA with the following information in Attachment 8:

1. Names, street addresses, and EINs of the applicant organizations;

2. Name, street address, and EIN of the parent organization;

3. Names, titles, email addresses, and phone numbers for points of contact at each of the applicant organizations and the parent organization;

4. Proposed RCORP-Implementation service areas for each applicant organization (these should not overlap);

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5. Justification for why each applicant organization must apply to this funding opportunity separately as the applicant organization, as opposed to serving as consortium members on other applications;

6. Assurance that the applicant organizations will each be responsible for the planning, program management, financial management, and decision making of their respective programs, independent of each other and/or the parent organization; and

7. Signatures from the points of contact at each applicant organization and the parent organization.

Applications associated with the same EIN must be independently developed and written. HRSA reserves the right to deem applications that provide insufficient information in Attachment 8 to be ineligible. In this instance, assuming all other eligibility criteria are met, HRSA will only accept the last validated electronic submission associated with the EIN.

Note that this exception does not apply to a single organization (e.g., a parent organization/headquarters) that wants to apply more than once for this funding opportunity on behalf of its satellite offices or clinics.

If multiple entities that share an EIN apply for this funding opportunity, the applicant organization names (as reflected in Box 8A of the SF-424 Application Page) should be different and reflect the names of the satellite offices/clinics. If HRSA receives multiple FY 2022 RCORP-Implementation applications with the same applicant organization name (as reflected in Box 8A of the SF-424 Application Page), only the last submitted and validated application will be reviewed.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-057 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

Application Page Limitation The total size of all uploaded files included in the page limit may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-057, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit.

It is the responsibility of the applicant to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 10-15: Other Relevant Documents.

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf 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

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Program Requirements and Expectations

HRSA requires that applicants be part of a broad, multi-sectoral consortia. For the purposes of RCORP-Implementation, a consortium is an organizational arrangement among four or more separately owned domestic public or private entities, including the applicant organization, with established working relationships. The entities, including the applicant organization, must all have different Employment Identification Numbers (EINs).9

HRSA expects that consortia funded by RCORP-Implementation will sustain the SUD/OUD-related services in rural areas made possible by this funding opportunity both during and beyond the period of performance. Over the course of the three-year period of performance, RCORP-Implementation award recipients will complete detailed plans for sustaining their consortia and SUD/OUD services beyond the RCORP- Implementation period of performance.

Finally, RCORP-Implementation award recipients are expected to work closely with a HRSA-funded technical assistance (TA) provider throughout the three-year period of performance. Targeted TA is provided to each award recipient at no additional cost, and is intended to help recipients achieve desired project outcomes, sustain services, align their performance reporting/evaluative activities, implement quality improvement efforts, and overcome challenges to project implementation. HRSA will provide more information about TA support upon receipt of award.

Program-Specific Instructions

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

Core Activities

Over the course of the three-year period of performance, consortia must implement all core activities described below, which are aimed at improving health care in HRSA-designated rural areas. If a consortium is already implementing one or more of the core activities within the service area, applicants may propose to expand or enhance those activities.

Note: Applicants must make progress on each core activity in every year of the grant.

Consortium members do not have to complete all required core activities individually, nor do all core activities have to be implemented in every part of the target rural service area. Implementation of the core activities should reflect the demonstrated needs and capacity of the target rural service area.

Foundational Core Activities

9Tribal entities may be exempt from this requirement. Please reference Eligible Applicants for more information.

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• Track and collect aggregate data and other information from consortium members to fulfill HRSA reporting requirements, and use this data to support continuous improvement of services and activities.

• Develop processes for achieving financial and programmatic sustainability beyond the period of performance, including (but not limited to) training providers, administrative staff, and other relevant stakeholders to optimize reimbursement for clinical encounters through proper coding and billing across insurance types.

• Address the SUD-related needs of populations that have historically suffered from poorer health outcomes or health disparities, as compared to the rest of the target rural population. Examples of these populations include, but are not limited to, persons/people experiencing homelessness, racial and ethnic minorities, people who are pregnant, adolescents and youth, LGBTQ individuals, the elderly, individuals with disabilities, etc.

• Leverage partnerships at the local/community, state, and regional levels, including with rural counties and municipalities, health plans, law enforcement, community recovery organizations, faith-based organizations, and others to secure buy-in for the proposed project and ensure that it complements (versus duplicates) existing SUD/OUD resources.

Prevention Core Activities

• Support culturally and linguistically appropriate substance use prevention activities and evidence-based programs, delivered in diverse environments (e.g., schools, community centers) and to diverse participants.

• Increase access to naloxone within the target rural service area and provide training on overdose prevention and naloxone administration for community members likely to respond to an overdose.

• Train community members and other stakeholders on safe storage and disposal of prescription drugs with potential for misuse.

• Identify and screen individuals at risk for SUD/OUD and co-occurring disorders disorders/infectious complications (including HIV, viral hepatitis, mental illness, etc.), and provide, or make referrals to, prevention, harm reduction, early intervention, treatment, and other support services.

• Train and strengthen collaboration with and between law enforcement and first responders to enhance their capability of responding and/or providing emergency treatment to those with SUD/OUD.

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Treatment and Recovery Core Activities

• Recruit, train, mentor, and retain interdisciplinary teams of clinical and social service providers, to support an integrated approach to SUD/OUD treatment, including evidence-based behavioral therapy (e.g., cognitive behavioral therapy, community reinforcement approach, etc.), U.S Food and Drug Administration-approved pharmacotherapy (e.g., buprenorphine, naltrexone), and any other necessary supportive services. This activity must include providing support to providers who are seeking DATA 2000 waivers.

• Create community linkages and referral systems for a seamless entry into MAT/SUD treatment from primary care, emergency departments, law enforcement/first responders, community-based organizations, social service organizations, etc.

• Ensure linkages to and coordination with home and community-based social services (such as case management, housing, employment, food assistance, transportation, etc.) to support individuals in recovery, including those discharged from inpatient treatment facilities and/or the criminal justice system.

• Expand the peer workforce to provide support in various settings, including hospitals, emergency departments, law enforcement departments, jails, SUD/OUD treatment programs, and in the community.

• Support the development of recovery support services such as recovery community organizations, recovery homes, mutual aid groups, and other recovery resources and infrastructure to expand the availability of and access to recovery support services.

Additional Activities

If capacity exists, award recipients may use funding to implement additional activities that strengthen the consortium’s ability to deliver prevention, treatment, and/or recovery services for SUD/OUD that improve health care in their service area. Applicants must provide detailed descriptions of all additional activities in the Project Narrative, as well as justifications for how those activities will advance RCORP-Implementation’s goal and fulfill the needs of the target population. No funding priority or preference is associated with proposing additional activities. Please see Appendix D for a non-exhaustive list of allowable additional activities

Requirements for Service Provision

All activities funded by this award must exclusively occur in HRSA-designated rural areas, as defined by the Rural Health Grants Eligibility Analyzer. Please note the exceptions under Eligible Applicants. Additionally, RCORP-Implementation is a payer of last resort, and award recipients should bill for all services covered by a reimbursement plan and make every reasonable effort to obtain payments. At the same time, award recipients may not deny services to any individual because of an inability to pay.

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Services should aim to eliminate pre-requisites to entering MAT, be individualized to the needs and circumstances of the patient, promote retention in treatment, recognize the need to manage recurrence of substance use and address ambivalence in patient motivation.

Target Population

The target population for this award are: 1) individuals who are at risk for, have been diagnosed with, and/or are in treatment and/or recovery for OUD; 2) their families and/or caregivers; and 3) other community members10 who reside in HRSA-designated rural areas, as defined by the Rural Health Grants Eligibility Analyzer.

Applicants are encouraged to focus on rural populations that have historically suffered from poorer health outcomes, health disparities, and other inequities, as compared to the rest of the target population, when addressing SUD in the proposed service area.

Examples of these populations include, but are not limited to, racial and ethnic minorities, people/persons experiencing homelessness, pregnant women, youth and adolescents, etc.

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment or it will count toward the page limitation. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

Please include the following information in your abstract:

1. Project Title

2. Requested Award Amount

3. Applicant Organization Name

4. Applicant Organization Address

5. Applicant Organization Facility Type (e.g., Rural Health Clinic, Critical Access

Hospital, Tribe/Tribal Organization, Health System, Institute of Higher Learning, Community-based Organization, Foundation, Rural Health Network, etc.)

6. Project Director Name and Title

7. Project Director Contact Information (phone and email)

8. Are you a current FY20 or FY21 RCORP-Implementation award recipient?

9. EIN Exception Request in Attachment 8? (Y/N) - Note: HRSA reserves the right to deem applications that provide insufficient information in Attachment 8, or are nearly identical in content, to be ineligible. In this instance, assuming all other eligibility criteria are met, HRSA will only accept the last submitted application associated with the EIN.

10. How the Applicant First Learned About the Funding Opportunity (select one:

State Office of Rural Health, HRSA News Release, Grants.gov, HRSA Project

10 Applicants are encouraged to include individuals in the community who are involved in improving health care in rural areas.

https://data.hrsa.gov/tools/rural-health

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Officer, HRSA Website, Technical Assistance Provider, State/Local Health Department)

11. Number of Consortium Members & List of Consortium Members

12. Previous or Current RCORP Award Recipient? (specify: FY18 RCORP-

Planning Applicant Organization; FY18 RCORP-Planning Consortium Member; FY19 RCORP-Planning Applicant Organization; FY19 RCORP- Planning Consortium Member; FY20 RCORP-Planning Application Organization; FY20 RCORP-Planning Consortium Member; FY19 RCORP- MAT Expansion; FY19 RCORP- Implementation Applicant Organization;

FY19 RCORP-Implementation Consortium Member, FY20 RCORP- Implementation Applicant Organization; FY20 RCORP-Implementation Consortium Member; FY 21 RCORP- Implementation Applicant Organization;

FY21 RCORP-Implementation Consortium Member; FY20 RCORP-NAS Applicant Organization; FY20 RCORP-NAS Consortium Member; FY21 RCORP-Psychostimulant Support Applicant Organization; FY21 RCORP- Psychostimulant Support consortium member)

13. Brief Description of the Target Population

- Indicate approximately what percentage (if any) of the target population is American Indian/Alaskan Native;

- If applicable, provide 2-3 sentences regarding how this project specifically targets tribal populations;

- If applicable, provide 2-3 sentences regarding how this project will target populations who have historically suffered from poorer health outcomes or health disparities, as compared to the rest of the target rural population (e.g., racial/ethnic minorities; persons/people experiencing homelessness; veterans; etc.).

14. Target Service Area (must be exclusively rural, as defined by the Rural Health Grants Eligibility Analyzer)

- Fully Rural Counties: Provide the county name and state

- Partially-Rural Counties: Provide county name, state, and the rural census tract (list of rural census tracts)

15. Does target service area overlap with an existing FY 19 or FY 20 RCORP-

Implementation award recipient’s service area? (Y/N)

NARRATIVE GUIDANCE

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

https://data.hrsa.gov/Content/Documents/tools/rural-health/forhpeligibleareas.pdf

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Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(4) Impact

Organizational Information (3) Evaluative Measures and

(5) Resources/Capabilities

Budget Narrative

(6) Support Requested - the budget narrative section should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

ii. Project Narrative

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

Use the following section headers for the narrative:

• INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 – “Need”

This section should clearly and succinctly summarize the overarching goals of the proposed project. In particular, you should provide a description of the target rural service area counties and/or rural census tracts; the characteristics and needs of the target population and service area; the consortium’s proposed approach to meeting those needs; and the consortium’s history of collaborating to address SUD/OUD in rural areas and capacity to implement the proposed project.

• NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 – “Need”

Describe, in detail, the needs of the target rural population as they relate to the core activities and any additional proposed activities. Provide supporting data and statistics from appropriate sources (e.g., local, state, tribal, and federal) that reflects the most recent timeframe available. Where possible, compare the data for the target rural population to regional, statewide, and/or national data to

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demonstrate need. Please cite the data sources (including year) you use to provide this data.

Applicants encountering difficulty obtaining data are encouraged to contact their state or local health departments and/or refer to data and information provided by the Rural Health Information Hub and the Opioid Misuse Community Assessment Tool developed by NORC at the University of Chicago. If you are still unable to locate appropriate and accurate data, please provide an explanation for why the data could not be found and how you will leverage the RCORP-Implementation award to strengthen the quality and availability of OUD/SUD data in your target rural service area.

Specifically, the Needs Assessment section should include detailed, quantitative descriptions of the following:

• The target rural population, including demographic and social determinants of health indicators;

o Describe the extent to which the population you propose to serve includes subpopulations that have historically suffered from poorer health outcomes, health disparities, and other inequities compared to the rest of the target population. Examples of these populations include, but are not limited to, persons/people experiencing homelessness, racial and ethnic minorities, people who are pregnant, adolescents and youth, LGBTQ individuals, the elderly, individuals with disabilities, etc.

o Describe which segments of the target rural population are most at risk for, and/or are most likely to be diagnosed with, OUD. This may include certain age groups, racial/ethnic groups, persons/people experiencing homelessness, etc.

• The prevalence and impact of SUD/OUD in the target rural service area.

Examples can include, but are not limited to, the number/ percentage of children in the foster care system as a result of their caregivers’ OUD;

number of individuals with infectious complications as a result of OUD; the number of SUD/OUD hospitalizations and/or emergency room visits; etc.

• Overview of existing SUD/OUD-related prevention, treatment, and recovery support services in the target rural service area, including any federal, state, or locally funded SUD/OUD initiatives such as other RCORP projects.

o Please reference the RCORP website for a list of RCORP award recipients in each program—Planning, Implementation, Neonatal Abstinence Syndrome, and MAT Expansion—as well as this table of RCORP award recipient service areas for more information.

• SUD/OUD-related health care needs and gaps in prevention, treatment, and recovery services in the target rural service area.

https://www.ruralhealthinfo.org/contact https://opioidmisusetool.norc.org/ https://opioidmisusetool.norc.org/ https://www.hrsa.gov/rural-health/rcorp https://www.rcorp-ta.org/sites/default/files/2020-11/RCORP%20County%20Representation%2010-29-2020.xlsx

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METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 – “Response”

The Methodology Section should provide clear, actionable strategies for how you will achieve each of the core activities. Your methodology should directly link to and reflect the data and information provided in the “Needs Assessment” section of the Project Narrative.

The methodology should include a thorough, detailed explanation of how you will achieve each core activity and how you will collaborate, and not duplicate, existing OUD/SUD programming in the target rural service area, including other RCORP awards. In addition, the methodology should also address the following for each set of core activities:

Foundational Core Activities

Explain in detail how your proposed approach to achieving the foundational core activities will improve health care in the target rural area and:

• Support consortium members to ensure that they are able to collect and report accurate, reliable data to fulfill HRSA reporting requirements.

Examples can include, but are not limited to, providing financial support to consortium members to strengthen their capacity to track and report data, and/or designating an individual at each consortium member organization who will be responsible for reporting that organization’s data to the applicant organization (in…