Modified BPHC HRSA-25-085 (H80) New Access Points.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2025

Bureau of Primary Health Care

Health Center Program

New Access Points

Funding Opportunity Number: HRSA-25-085

Funding Opportunity Type(s): New and Competing Supplement

Assistance Listing Number: 93.224

PHASE 1: Application Due Date in Grants.gov: August 15, 2024

PHASE 2: Supplemental Information Due Date in HRSA EHBs: September 30, 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: May 30, 2024

MODIFICATION & POSTING NOTICE

MODIFICATION DETAILS: Modified on July 12, 2024 - Appendix C added to provide clarification for Look-alike (LAL) sites.

Allison Arnone & Menna Girma Public Health Analysts, Bureau of Primary Health Care Call: 301-594-4300 Contact: BPHC Contact Form NAP technical assistance (TA) webpage See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act) https://hrsa.my.site.com/support/s/ https://bphc.hrsa.gov/funding/funding-opportunities/new-access-points http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim

HRSA-25-085 NAP ii

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: New Access Points (NAP)

Funding Opportunity Number: HRSA-25-085

Assistance Listing Number: 93.224

Due Date for Applications – Grants.gov:

Phase 1: August 15, 2024 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA Electronic Handbooks (EHBs):

Phase 2: September 30, 2024 (5 p.m. ET)

Purpose: To support new health center service delivery sites to expand affordable, accessible, and high-quality primary health care for underserved communities and populations.

Program Objectives: 1. Begin operations at all proposed sites within 120 days of the notice of award.

2. Demonstrate compliance with all Health Center Program requirements within 120 days of the notice of award.

Eligible Applicants:

Your organization must be a private, non-profit entity or a public agency in the United States or its territories. Tribal and urban Indian organizations may apply.

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

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Anticipated FY 2025 Total Available Funding:

$50,000,000

We’re issuing this notice to ensure that if funds become available for this purpose, we can process applications and award funds. We may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

Approximately 77 new grants

Estimated Award Amount: Up to $650,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required: No

Period of Performance: June 1, 2025 through May 31, 2026 (1 year)

Agency Contacts: Business, administrative, or fiscal issues:

Brian Feldman or Patrick Johnson Grants Management Specialists Division of Grants Management Operations, OFAM Email: bfeldman@hrsa.gov or pjohnson3@hrsa.gov

Program issues or technical assistance:

Allison Arnone & Menna Girma Public Health Analysts, Office of Policy and Program Development Bureau of Primary Health Care Contact: BPHC Contact Form

• Under Funding, select Applications for Notice of Funding Opportunities then NAP

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Two-Tier Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

mailto:bfeldman@hrsa.gov mailto:pjohnson3@hrsa.gov https://hrsa.my.site.com/support/s/ http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

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Technical Assistance

The Health Center Program Compliance Manual explains the Health Center Program requirements. You need to understand the requirements and show how you meet them in your application.

The NAP TA webpage includes:

• Application resources, such as example forms and documents.

• Answers to frequently asked questions.

• Details about our pre-application TA webinar.

• Contact information for questions.

The HRSA Primary Health Care Digest is a weekly email newsletter containing updates about the Health Center Program, including funding opportunities and technical assistance.

You can search the HRSA-supported Health Center Resource Clearinghouse to find many health center resources.

The Strategic Partnerships webpage lists HRSA-supported training and TA partners.

They may provide you with resources to support your application, including applicants serving people experiencing homelessness, public housing residents, and migratory and seasonal agricultural workers.

The National Health Service Corps (NHSC) has resources for provider recruitment, including the Health Workforce Connector.

If you receive Health Center Program funds, you will be eligible for federal benefits. For details, see Section VIII. Other Information.

Summary of Major Changes since FY 2019 NAP

• We clarified that if you do not verify a site within 120 days of award, we will apply a condition to your award that provides 120 more days for your site to open.

• A satellite applicant may propose to use funds to add only a new mobile unit that provides services at least 40 hours per week.

• HRSA will award NAP funding as new grant awards with a 1-year period of performance.

• Award recipients must provide mental health and substance use disorder services.

You may propose to provide these services directly, though a contract, or through a formal referral arrangement.

• If you request funding for Health Care for the Homeless (HCH) or Public Housing Primary Care (PHPC), you must verify on the Summary Page that you will use this https://bphc.hrsa.gov/compliance/compliance-manual https://bphc.hrsa.gov/funding/funding-opportunities/new-access-points https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://www.healthcenterinfo.org/ https://bphc.hrsa.gov/technical-assistance/strategic-partnerships https://nhsc.hrsa.gov/ https://bhw.hrsa.gov/provider-recruitment/health-workforce-connector

HRSA-25-085 NAP v funding to supplement, and not supplant, other resources for the delivery of services to these populations.

• A Work Plan in EHBs replaced the Operational Plan attachment.

• We removed Form 10: Emergency Preparedness Report and the Performance Measure forms.

• All applicants must provide proof that they are eligible organizations (see Attachment 11).

• The page limit is 90 pages, which does not include attachments required for eligibility such as the bylaws, co-applicant agreement, and proof of non-profit or public status.

• We updated the Funding Priorities:

o High-need area priority points include higher thresholds for the Unmet Need Score and the unserved low-income population.

o Sparsely populated priority points include zip codes designated as Level 3 and 4 frontier and remote (FAR) areas.

o Look-alike priority points changed. Performance now accounts for 5 points, and the proposal of a new, full-time service site accounts for 5 points.

• We updated how we calculate the Unmet Need Score (UNS) for look-alikes that propose a new site. We may base the UNS on the service area zip codes listed on Form 5B for the new site only. See unmet need for details.

• We updated the GEOGRAPHIC CONSIDERATION OF NEED and SERVICE AREA EXPANSION criteria. You must submit extra documentation in Attachment 12 and HRSA may not fund your application if:

o You propose a NAP site within 1 mile of a current Health Center Program award recipient or look-alike site.

o Your proposed service area has a Health Center Program penetration level of the low-income population that is 50 percent or greater (per GeoCare Navigator).

o You select “urban” on Form 1A, and your proposed NAP site is more than 15 miles from your closest current Health Center Program service delivery site or from your closest proposed NAP site, if proposing multiple sites.

o You select “rural” on Form 1A, and your proposed NAP site is more than 30 miles from your closest current Health Center Program service delivery site or from your closest proposed NAP site, if proposing multiple sites.

https://geocarenavigator.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 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. Program-Specific Forms (Submit in EHBs)

vi. Attachments (Submit in EHBs)

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: ONE-TIME FUNDING REQUEST INFORMATION

APPENDIX C: CLARIFICATION FOR LOOK-ALIKE (LAL) SITES

HRSA-25-085 NAP 1

I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) announces the opportunity to apply for New Access Points (NAP) funding under the Health Center Program. The purpose of this funding is to support new health center service delivery sites to expand affordable, accessible, and high-quality primary health care for underserved communities and populations. In this NOFO, such sites are referred to as new access points. Award recipients will use NAP funding to provide primary health care services at one or more new access points.

See Program Requirements and Recommendations for more details.

2. Background

The Health Center Program is authorized by 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act).

The Health Center Program supports nearly 1,400 health centers that provide primary health care services to more than 30.5 million people. NAP funding targets the nation’s high-need geographic areas and medically underserved populations, including low-income, uninsured people. NAP is the main way that organizations become funded health centers.

Health centers provide patient-centered primary health care that combines medical, dental, and behavioral health services. Health centers also provide enabling services that make it easier for people to get health care and connect patients to community resources that address social determinants of health.1

There are 3 types of organizations that can apply for NAP:

• A NEW START applicant is an organization that does not currently receive operational (H80) grant funding from the Health Center Program and is not currently designated as a Health Center Program look-alike. The NAP application should address the entire project proposed for NAP funding.

• A LOOK-ALIKE applicant is an organization designated as a Health Center Program look-alike. The NAP application should address the look-alike scope of project and any proposed new site(s), areas, and populations. If awarded, you will stop being a look-alike and become a funded health center (H80). All sites in your look-alike scope of project and in the NAP application will become part of the H80 scope of project.2

1 Social determinants of health (SDOH) affect a wide range of health and quality-of-life outcomes and risks. HHS groups SDOH into 5 areas: economic stability; education access and quality; health care access and quality; neighborhood and built environment; and social and community context. See Healthy People 2030 for more information.

2 Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-1.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html

HRSA-25-085 NAP 2

• A SATELLITE applicant is an organization currently receiving operational funding from the Health Center Program (H80 grant funding). The NAP application should address ONLY the proposed new sites, areas, and populations.

In your NAP application, you will request funding to serve one or more specific population types as described below:

COMMUNITY HEALTH CENTER (CHC) APPLICANTS:

• Comply with PHS Act section 330(e) and program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health services to underserved populations in the service area.

MIGRANT HEALTH CENTER (MHC) APPLICANTS:

• Comply with PHS Act section 330(g); and as applicable, section 330(e), program regulations, requirements, and policies.

• Provide work-related health services such as injury prevention and screening for parasitic infections.

• Provide a plan that ensures the availability and accessibility of required primary health services to migratory and seasonal agricultural workers and their families in the service area. They include:

o Migratory agricultural workers whose main job has been in agriculture within the last 24 months, and who have a temporary home because of that job.

o Seasonal agricultural workers whose main job is in agriculture on a seasonal basis and who do not meet the definition of a migratory agricultural worker.

o People who are no longer employed in migratory or seasonal agriculture because of age or disability who are within your service area; and/or o Family members of those described above.

Note: Agriculture refers to farming in all its branches (Section 330(g) of the PHS Act), as defined by the North American Industry Classification System under codes 111, 112, 1151, and 1152 (48 CFR § 219.303).

HEALTH CARE FOR THE HOMELESS (HCH) APPLICANTS:

• Comply with PHS Act section 330(h); and as applicable, section 330(e), program regulations, requirements, and policies.

• Provide substance use disorder services.

• Provide a plan that ensures the availability and accessibility of required primary health services to people:

o Who lack housing (whether or not the person is a part of a family);

HRSA-25-085 NAP 3

o Whose main residence during the night is a supervised public or private facility that provides temporary lodging;

o Who live in transitional housing;

o Who live in permanent supportive housing or other housing programs for people experiencing homelessness; and/or o Who are children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness.

PUBLIC HOUSING PRIMARY CARE APPLICANTS (PHPC)3

• Comply with PHS Act section 330(i); and as applicable, section 330(e), program regulations, requirements, and policies.

• Consult with residents of the proposed public housing sites on the planning and administration of the program.

• Provide a plan that ensures the availability and accessibility of required primary health services to residents of public housing and people living in areas immediately accessible to public housing.

o Public housing is low-income housing that is developed, owned, or assisted by a public housing agency, including mixed finance projects.

o Public housing does not include housing units that accept Section 8 housing vouchers, but do not receive other support from a public housing agency.

II. Award Information

1. Type of Application and Award

Application type(s): New (for new start and look-alike applicants) and Competing Supplement (for satellite applicants).

Awards will be in the form of a grant.

2. Summary of Funding

We estimate $50,000,000 will be available each year to fund approximately 77 awards.

Of this total, approximately:

• $40,750,000 is expected to be available for applicants requesting CHC funding.

3 For a proposed site that will serve public housing residents under Section 330(i), the site must be located in public housing or immediately accessible to public housing. “Immediately accessible” means that the proposed site is next to the public housing and to the extent possible, there are no physical barriers that prevent public housing residents from accessing the site (for example, a highway or river).

HRSA-25-085 NAP 4

• $4,300,000 is expected to be available for applicants requesting MHC funding.

• $4,350,000 is expected to be available for applicants requesting HCH funding.

• $600,000 is expected to be available for applicants requesting PHPC funding.

You may apply for up to $650,000 (reflecting direct and indirect costs). Of the $650,000, you may request Health Center Program funding up to $250,000 for one-time costs for equipment and/or minor alteration/renovation (see Appendix B).

The period of performance is June 1, 2025 through May 31, 2026 (1 year). 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. The estimated awards depend on the future appropriation of funds and are subject to change based on the availability and amount of appropriations.

If you receive a satellite NAP award, we will award the NAP funding as a new grant award, separate from your current Health Center Program (H80) award. Under 45 CFR § 75.302, you must document use of NAP funds separately and distinctly from other Health Center Program funds and other federal award funds. You must maintain your H80 award status to maintain your NAP funding.

All uses of NAP funds must align with your proposed scope of project. Once funded, your scope of project includes the approved service sites, services, providers, service area, and target population that are supported (wholly or in part) under your total approved health center budget. You must comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable law and regulations.

Funding Beyond the 1-Year Period of Performance

Funding beyond the 1-year period of performance depends on availability of funds and the following:

• New start and look-alike NAP award recipients must apply for Service Area Competition (SAC) funding. The SAC application will be due approximately midway through the NAP period of performance. We will consider progress toward the NAP post-award objectives when making final SAC award decisions.

• We will assess satellite NAP award recipients’ progress toward the NAP post-award objectives approximately 8 months into the NAP period of performance.

The assessment may result in continued, reduced, or no additional funding. We may extend the NAP period of performance with or without funds and/or make the NAP funding available under your current H80 award.

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

https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html 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

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III. Eligibility Information

1. Eligible Applicants

Eligibility Requirement What We Check

1) Your organization must be a private, non-profit entity or a public agency in the United States or its territories. Tribal and urban Indian organizations may apply.4

• Attachment 11: Evidence of Non-profit or Public Agency Status

2) Your organization must provide all required health services to medically underserved populations, as defined in section 330 of the PHS Act.5

• Project Narrative RESPONSE section

• Form 5A: Services Provided

3) You must propose at least one service delivery site that provides primary medical care as its main purpose and is open for at least 40 hours per week (full-time).

• NEW START and LOOK-ALIKE APPLICANTS must propose a full-time, fixed (not mobile), service delivery site.

o If you apply for only MHC funding, this site may be permanent or seasonal.

o If you apply for any other type of funding (CHC, HCH, PHPC), this site must be permanent (operating year-round).

• SATELLITE APPLICANTS must propose a full-time service delivery site. This site may be fixed or mobile.

o If you apply for only MHC funding, this site may be permanent, seasonal, or mobile.

o If you apply for any other type of funding (CHC, HCH, PHPC), this site may be permanent or mobile (operating year-round).

• Form 1A: General Worksheet: The number of projected medical patients must be greater than projected patients for other service types.

• Form 5A: Services Provided: You must provide General Primary Medical Care directly (Column I) or through contracts the health center pays for (Column II).

• Form 5B: Service Sites:

You must select an eligible Location Type (permanent, seasonal, or mobile) based on your proposed NAP project. A permanent site is a fixed building location that operates year-round. A seasonal site is a fixed building location that operates for less than 12 months out of the year.

4 Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

5 Refer to the Service Descriptors for Form 5A: Services Provided for details regarding required primary health care services.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-1.html https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf

HRSA-25-085 NAP 6

Eligibility Requirement What We Check

4) You must make services accessible to all. You may not propose to serve ONLY a single age group or address a single health issue or disease. If you propose only a school-based service site(s), you must explain how you will make all required services available to the entire underserved population in the service area.

• Project Narrative RESPONSE section

5) Your NAP site(s) must have a valid street address, in an area with unmet need for health services. You may not propose a site that:

• Is in the same building as a site already in the approved scope of project of any Health Center Program award recipient or look-alike.6 o Exception: Look-alike applicants should include their own look-alike sites as part of their NAP application.

• Relocates, replaces, or merges sites already in your scope of project.

• Is waiting to be verified operational through an active Change in Scope request or a funded Health Center Program award (including SBSE, CARE, and ARP-Capital)7 at the time of application.

• Form 5B: Service Sites

• Health Center Program scope of project: Visit Find a Health Center to see the addresses for current Health Center Program service sites.

6) NEW START APPLICANTS: If you apply for CHC funding, you must propose to serve an area that is designated, in whole or in part, as a Medically Underserved Area or Population (MUA/P).

To find out if all or part of your service area is designated as an MUA/P, see MUA Find or Find Shortage Areas by Address.

• Form 1A: General Information Worksheet:

Enter the MUA/P number(s) or indicate the MUA/P is pending.

• Attachment 1: Service Area Map

6 Sites cannot be in the same building as any service delivery or administrative/service delivery site.

7 These are Health Center Program awards for School-Based Service Expansion, Capital Assistance for Hurricane Response and Recovery Efforts, and American Rescue Plan Capital Improvements.

https://bphc.hrsa.gov/funding/funding-opportunities/school-based-service-expansion/fy-2023-awards https://bphc.hrsa.gov/funding/funding-opportunities/capital-assistance-hurricane-response-recovery-effort/fy-2023-awards https://bphc.hrsa.gov/funding/coronavirus-related-funding/fy-2021-american-rescue-plan-construction-capital-improvements/awards http://findahealthcenter.hrsa.gov/ http://findahealthcenter.hrsa.gov/ https://data.hrsa.gov/tools/shortage-area/mua-find https://data.hrsa.gov/tools/shortage-area/by-address https://data.hrsa.gov/tools/shortage-area/by-address

HRSA-25-085 NAP 7

Eligibility Requirement What We Check

7) PUBLIC HOUSING PRIMARY CARE

APPLICANTS: If you apply for PHPC funding, you must consult with public housing residents as you plan your new site(s). You must also explain how you will have ongoing input from public housing residents.

• Project Narrative RESPONSE section

8) HEALTH CARE FOR THE HOMELESS AND

PUBLIC HOUSING PRIMARY CARE

APPLICANTS: If you apply for HCH or PHPC funding, you must use this funding to supplement, and not supplant, the expenditures of the health center and the value of in-kind contributions for the delivery of services to these populations.

• Summary Page: Describe how NAP funds will increase the level of services you provide to these populations.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

We may consider your application ineligible for review if it:

• Requests more than $650,000.

• Does not include a Project Narrative, Attachment 2: Bylaws, and Attachment 11:

Evidence of Non-profit or Public Agency Status.

• Does not include Attachment 6: Co-Applicant Agreement, if you are a public agency with a co-applicant.

• Fails to meet the deadlines referenced in Section IV.4.

• Is submitted on behalf of another organization or does not demonstrate that the applicant organization (as listed on the SF-424) will perform a substantive role in the project. Evidence that the applicant organization is performing a substantive role in the project may include providing general primary medical care directly through the applicant organization’s employees and sites.

Multiple Applications

We will only review your first validated application under HRSA-25-085 in Grants.gov. If you wish to change attachments submitted in Grants.gov, you may do so in the EHBs application phase.

https://grants.hrsa.gov/2010/WebEPSExternal/Interface/Common/AccessControl/Login.aspx

HRSA-25-085 NAP 8

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov and EHBs. Use the SF-424 workspace application package associated with this NOFO. You must use a two-phase submission process. Follow these directions: How to Apply for Grants and those in EHBs.

• Phase 1 – Grants.gov – You must submit your application via Grants.gov by August 15, 2024, at 11:59 p.m. ET, and

• Phase 2 – EHBs – You must submit your application via EHBs by September 30, 2024 at 5 p.m. ET.

Only applicants who successfully submit the workspace application package for this NOFO in Grants.gov (Phase 1) by the due date may submit the additional required information in EHBs (Phase 2). If you wish to change information you submitted in EHBs, you may reopen and revise your application before the EHBs deadline. For more details, see Sections 3 and 4 of the Two-Tier Application Guide.

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

Select “Subscribe” and enter your email address for HRSA-25-085 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 Follow instructions in Sections 4 and 5 of the Two-Tier Application Guide and this NOFO. Write your application in English. Use U.S. dollars for your budget. There’s an Application Completeness Checklist in the Two-Tier Application Guide to help you.

In Grants.gov (Phase 1), submit your:

• Application for Federal Assistance (SF-424) o Box 2: Type of Applicant, select:

New if you are not a current Health Center Program award recipient (including look-alikes)

Satellite if you are a current Health Center Program award recipient. Check the “Revision” box, select “Other” and type “Supplement” o Box 4: Applicant Identifier: Enter your 10-digit H80 or LAL number, as applicable https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-app-guide-2-tier.pdf#page=61

HRSA-25-085 NAP 9

• Project Abstract Summary

• Project/Performance Site Locations (enter information for your primary service delivery site)

• Grants.gov Lobbying Form

• Key Contacts

In EHBs (Phase 2), submit your:

• Project Narrative

• SF-424A Budget Information Form

• Budget Narrative and Table of Personnel Paid with Federal Funds

• Program-Specific Forms

• Attachments

Application Page Limit

The page limit for your application is 90 pages. We will not review any pages that exceed the page limit. Using the pages within the page limit, we will determine eligibility using Section III. Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms in the NOFO’s workspace application package and program-specific forms in EHBs

• Attachments that are uploaded to program-specific forms in EHBs

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

• Indirect Cost Rate Agreement

• Attachments required to determine eligibility, such as bylaws, co-applicant agreement, and proof of non-profit or public status

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-25-085 workspace application package or EHBs application, it may count toward the page limit. Therefore, we recommend you only use Grants.gov and EHBs workspace forms for this NOFO to avoid exceeding the page limit.

It is important to ensure your application does not exceed the specified page limit. See Appendix A: Applicant Page Limit Worksheet for additional information.

HRSA-25-085 NAP 10

Applications must be complete, validated by Grants.gov, and submitted under HRSA-25-085 before the Grants.gov and EHBs deadlines.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals8 (for example, program director) 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.9

• If you cannot certify this, you must explain why in Attachment 12: Other Relevant Documents.

See Section 5.1 viii – Certifications of the Two-Tier Application Guide.

Program Requirements Sites and population types:

You may request funding for one or more sites that meet the definition of a service site.

See PIN 2008-01: Defining Scope of Project and Policy for Requesting Changes. At least one site must meet the eligibility requirements in Section III.

You may request funding to serve one or more population types (CHC, MHC, HCH, PHPC). For example, if you plan to serve both the general community and people experiencing homelessness, you may apply for both CHC and HCH funding. See Section I for each population type’s requirements.

Required Services:

Your application must demonstrate that you will provide all required health services and mental health and substance use disorder services. See the Service Descriptors for Form 5A: Services Provided for details about these services. You may provide these services directly, through a contract, or through a formal referral arrangement.

Post-award objectives:

Your application must demonstrate how you will achieve 2 objectives that will be assessed post-award:

1. Open all proposed sites within 120 days of the notice of award. Staff and systems must be in place to deliver primary health services to the proposed population(s). In the Project Narrative and Work Plan, you will describe your plan to open the site(s)

8 See definitions at 2 CFR § 180.995 -- Principal and 2 CFR § 376.995 -- Principal.

9 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.hrsa.gov/sites/default/files/hrsa/grants/two-tier-application-guide.pdf https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/pdf/pin2008-01.pdf https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf https://www.ecfr.gov/current/title-2/section-180.995 https://www.ecfr.gov/current/title-2/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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listed on Form 5B: Service Sites and provide the services listed on Form 5A:

Services Provided.

2. Demonstrate compliance with all Health Center Program requirements within 120 days of the notice of award. You will document how you will be compliant in the Project Narrative, Work Plan, and other forms and attachments.

How we will track your progress on the objectives:

For objective 1, you must verify when each site is open. If you do not verify that a site is open within 120 days of award, we will place a condition on your award. That condition will provide up to 120 more days for your site to open. If you do not resolve a site-related condition within the specified timeframes, HRSA may terminate all, or part, of your NAP award per 45 CFR § 75.371.

You must verify when you start providing new services. HRSA will also verify your services and hours of operation during your Operational Site Visit (OSV).

For objective 2, the requirements are detailed in the Health Center Program Compliance Manual.

• If you receive funding as a new start or look-alike applicant, HRSA will assess your compliance during an OSV conducted approximately 120 days after award.

HRSA may choose to delay your OSV until after your site(s) are open.

• If you receive funding as a satellite applicant, you will have an OSV during your current H80 period of performance.

If you are not compliant during the OSV, we will place conditions on your award. See Chapter 2 of the Compliance Manual to learn more about oversight.

Service area:

You must propose a service area that reflects where your projected patients live. See Chapter 3 of the Compliance Manual for things to consider, including political subdivisions, size, and how your NAP sites fit with your existing service area (if you have one). You will show this in Attachment 1: Service Area Map and Table.

Projected patients:

You will project an achievable number of patients that you expect to serve through your NAP project in 2026 on Form 1A: General Information Worksheet. If you do not serve the number of patients you project to serve in 2026, HRSA may reduce funding when you apply to a future Service Area Competition.

Unmet need:

HRSA uses the Service Area Needs Assessment Methodology (SANAM) to create an unmet need score (UNS) for each application. The UNS is an objective assessment of unmet need. The SANAM uses public data sources to calculate an UNS for every zip https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFRb1309e6966399c7/section-75.371 https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/compliance/compliance-manual/chapter2 https://bphc.hrsa.gov/compliance/compliance-manual/chapter3

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code.10 The UNS for each service area zip code (on Form 5B: Service Sites) is combined to establish the UNS for your application. The application-level UNS can be viewed at the Unmet Need Score Map Tool and appears in EHBs. The UNS is up to 20 points of the NEED section score and is a factor in one of the funding priorities. See Understanding Service Area Needs for more information on SANAM and UNS.

For look-alike applicants that propose a new, full-time (fixed or mobile) site that provides primary medical care as its main purpose, HRSA will also calculate the UNS for the service area zip codes listed on Form 5B for the new site using the Unmet Need Score Map Tool. HRSA will use the higher UNS for your NAP application. See Appendix C:

Clarification for Look-alike (LAL) Sites for additional information.

Consult and collaborate:

You must consult with the following about the need for your proposed project:

• State and local government agencies (such as the local health department, state Medicaid agency, and state Primary Care Office).

• Health care providers (such as safety net hospitals, and other providers serving Medicaid patients).

You will describe how you will use input from patients and the community to impact community health needs. You will also describe how you will collaborate and coordinate with community partners in your proposed service area. You will document this in the Project Narrative and certify on the Summary Page.

Program Recommendations

When planning your project, consider:

• How to expand health care access11 for high-need communities and reduce health disparities.

• How to increase access to services for low-income patients without health insurance, including at school-based service sites.

• How your team’s cultural and clinical competence can impact the patient experience.

• Barriers such as trauma, discrimination, and stigma that people may experience when seeking health care.

10 HRSA uses Zip Code Tabulation Areas (ZCTAs) to calculate the UNS. Each ZCTA is associated with one or more zip codes.

11 See the Unmet Need Score Resource Guide for information about these 5 parts of health care access:

Availability, Affordability, Approachability, Acceptability, and Appropriateness.

https://data.hrsa.gov/topics/health-centers/sanam https://bphc.hrsa.gov/funding/health-center-service-area-needs https://data.hrsa.gov/topics/health-centers/sanam https://data.hrsa.gov/topics/health-centers/sanam https://bphc.hrsa.gov/sites/default/files/bphc/programopportunities/fundingopportunities/NAP/uns_resource_guide.pdf

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• Social risk factors such as food insecurity, housing insecurity, financial strain, or lack of transportation.12

• Other health-related social needs that may affect access to care, contribute to poor health outcomes, and worsen health disparities.

• How the NAP award can improve your performance.13

Program-Specific Instructions Follow application requirements and instructions from Section 5 of the Two-Tier Application Guide (budget, budget narrative, personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form 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 5.1.ix of the Two-Tier Application Guide. In addition, include your proposed service delivery site address(es) and the estimated number of new patients you will serve in 2026 across your proposed NAP sites.

NARRATIVE GUIDANCE

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

Narrative Section, Forms, Attachments Review Criteria

• Need section of the Project Narrative

• Attachments and Forms listed in the Need section

Criterion 1: Need

• Response section of the Project Narrative

• Attachments and Forms listed in the Response section

Criterion 2: Response

• Collaboration section of the Project Narrative

• Attachments listed in the Collaboration section

Criterion 3: Collaboration

12 See the 2023 UDS Manual for information about reporting social risk factors.

13 See the Advancing Health Center Excellence Framework.

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-program-specific-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-program-specific-app-guide.pdf https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf https://bphc.hrsa.gov/focus-areas/advancing-health-center-excellence#advancing

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Narrative Section, Forms, Attachments Review Criteria

• Impact section

• Forms listed in the Impact section

Criterion 4: Impact

• Resources/Capabilities section of the Project Narrative

• Attachments and Forms listed in the Resources/Capabilities section

Criterion 5:

Resources/Capabilities

• Governance section of the Project Narrative

• Attachments and Forms listed in the Governance section

Criterion 6: Governance

• Support Requested section of the Project Narrative

• Attachments and Forms listed in the Support Requested section

Criterion 7: Support Requested

ii. Project Narrative

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

Your Project Narrative must reflect your NAP proposed scope of project (proposed services, providers, sites, service area zip codes, and target population). If you are a satellite applicant, you may refer to current services, policies, procedures, and capacity as they relate to the NAP project.

Provide information in the following order. Use the section headings. Number your responses in each section. This ensures reviewers can understand your proposed project.

NEED – Corresponds to Section V.1 Review Criterion 1: NEED

1) Describe the proposed service area (consistent with Attachment 1: Service Area Map and Table), including:

a) How the service area overlaps with political subdivisions like counties, cities, townships, and school districts.

• If all the zip codes in your proposed service area are not next to each other, or do not border your current Health Center Program service area (if applicable), explain why.14

14 HRSA may choose not to fund your NAP application if your proposed NAP site is more than 15 miles from your other sites in an urban area, or more than 30 miles from your other sites in a rural area. See Section V.2 for details.

HRSA-25-085 NAP 15

b) How the service area reflects where most of your proposed patients live.

c) How the service area is currently served by the Health Center Program, including:

• The locations of current health centers and how close they are to your proposed NAP site(s).15 If your NAP site is within 1 mile of another health center site, you will provide more information in Attachment 12.

• How much your target population is already served by current health centers. Discuss your service area’s overall Health Center Program penetration percentage from Attachment 1: Service Area Map and Table.

d) How much of your target population is currently served by other primary health care providers such as rural health clinics, critical access hospitals, and private providers serving Medicaid patients.

e) If it is located in an Opportunity Zone.

2) Describe health care needs that are not being met in your proposed service area. If you are applying for MHC, HCH and/or PHPC funding, include the unmet needs of each targeted special population. Cite relevant data and their sources, which may include the UNS. Address the following:

a) Gaps in available primary care, including behavioral health services.

b) Factors that affect health care access, outcomes, and disparities.

c) Any other health-related social needs (if applicable).

3) Describe how the following informed your proposed NAP project:

a) Community input.

b) Patient board members’ lived experience.

4) Provide a brief overview of your consultation with state and local government agencies (such as the health department, state Medicaid agency, state Primary Care Office) and other health care providers about the need for your NAP site(s).

RESPONSE – Corresponds to Section V.1 Review Criterion 2: RESPONSE

1) Describe how your proposed NAP site location(s) noted on Form 5B: Service Sites and Attachment 1: Service Area Map and Table will support equitable access to services and minimize barriers identified in the NEED section.

2) Complete the work plan on the Project Overview Form in EHBs by describing activities that will help you achieve the 2 post-award objectives and provide comprehensive health services for the proposed number of hours per week at each

15 If your proposed NAP site is within 1 mile of another health center service delivery site or look-alike site, HRSA may choose not to fund your NAP application. See Section V.2 for details.

https://www.irs.gov/credits-deductions/businesses/opportunity-zones https://data.hrsa.gov/topics/health-centers/sanam

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site. See the NAP TA webpage for a sample. The work plan should be consistent with Form 2: Staffing Profile, Form 5A: Services Provided, minor A/R forms, and Attachment 7: Summary of Contracts and Agreements, as applicable.

3) Describe how you will reach those with the greatest need in your service area (for example, uninsured, low-income, chronically ill).

4) Document how you will provide all required services and any proposed additional services on Form 5A: directly (Column I), through contracts that the health center pays for (Column II), or through formal referral arrangements (Column III).16 In the narrative, address the following:

a) How all age groups will have access to all required services and any additional services.

b) Which required services on Form 5A you will not provide in-person at all NAP site(s) and how you will make those services accessible to all patients.

c) How you will support continuity, clinical effectiveness, and patient-centered care coordination.

d) How your services will account for individual patient preferences, culture, values, and needs (including language and access needs).17

e) How you will make mental health and substance use disorder services available to all patients.

f) Applicants requesting MHC funding: How you will provide work-related health services such as injury prevention and screening for parasitic infections.

g) Applicants requesting HCH funding:

• How you will provide substance use disorder services (consistent with Form 5A).

• How you will provide services to people who have needs that may be best met at locations other than your fixed sites. This includes providing care through street medicine, using a mobile unit, or partnering with other organizations.

h) Applicants requesting PHPC funding:

• How you consulted with public housing residents in the proposed service area as you developed the NAP service delivery plan.

• How you will involve public housing residents in administration of the proposed NAP project.

16 Refer to Scope of Project, including the Column Descriptors for Form 5A: Services Provided.

17 See HRSA: Culture, Language, and Health Literacy and Think Cultural Health for more information.

https://bphc.hrsa.gov/funding/funding-opportunities/new-access-points http://bphc.hrsa.gov/programrequirements/scope.html https://bphc.hrsa.gov/sites/default/files/bphc/compliance/form-5a-column-descriptors.pdf https://www.hrsa.gov/cultural-competence/index.html https://thinkculturalhealth.hhs.gov/

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5) Describe how you will provide the following enabling services:

a) Patient case management, informing patients about insurance options, helping patients apply for government assistance programs, and linking to community partners.

b) Connecting people to health center services, such as street outreach, community health worker, and peer navigator activities.

c) Transportation.

d) If a substantial number of the proposed patients are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken.

e) Health education and informing the public that:

• You provide care regardless of the ability to pay.

• You provide sliding fee discounts.

6) Describe the following aspects of your sliding fee discount program policies:

a) How you assess all patients for sliding fee discount eligibility based only on income and family size.

b) How you adjust patient charges based on the ability to pay (consistent with Attachment 8: Sliding Fee Discount Schedule).

c) Whether you have a nominal charge18 for patients with incomes at or below 100 percent of the Federal Poverty Guidelines (FPG). If so, describe how the amount is nominal from the perspective of the patient19 and would not reflect the actual cost of the service being provided.

d) How you evaluate your sliding fee discount program to ensure that it reduces financial barriers to care.

COLLABORATION – Corresponds to Section V.1 Review Criterion 3: COLLABORATION

1) Describe your efforts to collaborate with…