NOFO HRSA-24-103 (UP8) State Health Services and Financing.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Office of Intergovernmental and External Affairs

Office of External Affairs

National Organizations of State and Local Officials (NOSLO):

State Health Services and Financing

Funding Opportunity Number: HRSA-24-103

Funding Opportunity Type(s): New

Assistance Listing Number: 93.011

Application Due Date: May 23, 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: February 23, 2024

Kellie J. Cosby Public Health Analyst, Office of External Affairs Office of Intergovernmental and External Affairs Call: (301)-443-8997 Email: KCosby@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Section 311(a) of the Public Health Service (PHS) Act (42 USC §243(a)) mailto:KCosby@hrsa.gov

HRSA-24-103 NOSLO i

508 COMPLIANCE DISCLAIMER

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

SUMMARY

Funding Opportunity Title: National Organizations of State and Local Officials:

State Health Services and Financing

Funding Opportunity Number: HRSA-24-103

Assistance Listing Number: 93.011

Due Date for Applications: May 23, 2024

Purpose: The purpose of this National Organizations of State and Local Officials (NOSLO): State and Health Services Financing program is to assist state and local authorities in:

a) improving public health, health care, and health care delivery,

b) building capacity to address public health issues and support and enforce regulations intended to improve the public’s health, and

c) promoting health equity to preserve and improve public health.

Program Objective(s): This cooperative agreement will assist states in leveraging HRSA programs and identifying collaborations with Medicaid to improve access to quality health care for high need communities.

Eligible Applicants:

Eligible applicants include domestic public or private, non-profit, or for-profit entities, including community-based organizations, tribes, and tribal organizations.

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

Anticipated FY 2024 Total Available Funding:

Up to $500,000.

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

Estimated Number and Type of Award(s):

One cooperative agreement.

Estimated Annual Award Amount:

Up to $500,000 per year, subject to the availability of appropriated funds. If additional funds become available, the budget will increase to a higher amount.

Cost Sharing or Matching Required:

No

Period of Performance: September 30, 2024, through September 29, 2027 (3 years)

Agency Contacts: Business, administrative, or fiscal issues:

Djuana Gibson Grants Management Specialist Division of Grants Management Operations, OFAM Health Resources and Services Administration Email: DGibson@hrsa.gov

Program issues or technical assistance:

Kellie J. Cosby Public Health Analyst, Office of External Affairs Office of Intergovernmental and External Affairs Email: KCosby@hrsa.gov

Application Guide

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

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

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Technical Assistance

We have scheduled the following webinar:

Tuesday, March 12, 2024 1 p.m. – 2 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1601821840?pwd=MFdJdHE1bms1amg0aWxnNTB6Ty9tQT09

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

Call-In Number: 1-833-568-8864 Meeting ID: 160 182 1840

We will record the webinar. For a recording of the webinar, please email hrsaieaexternalaffairs@hrsa.gov https://hrsa-gov.zoomgov.com/j/1601821840?pwd=MFdJdHE1bms1amg0aWxnNTB6Ty9tQT09 https://hrsa-gov.zoomgov.com/j/1601821840?pwd=MFdJdHE1bms1amg0aWxnNTB6Ty9tQT09 mailto:hrsaieaexternalaffairs@hrsa.gov

HRSA-24-103 NOSLO iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: NOSLO PROGRAM APPLICATION TRACKS

APPENDIX B: NOSLO PROGRAM PERFORMANCE MEASURES

APPENDIX C: NOSLO PROJECT WORK PLAN MATRIX TEMPLATE

APPENDIX D: PAGE LIMIT WORKSHEET

HRSA-24-103 NOSLO 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the National Organizations of State and Local Officials (NOSLO) Program: State Health Services and Financing to fund a national level organization with an in-depth understanding of, and experience with, providing technical assistance and support to State Medicaid Directors and other health care payment officials to assist states in leveraging HRSA programs and collaborating with Medicaid to improve access to quality health care for high need communities. Activities should include but are not limited to fostering collaborations to address maternal health disparities, bolster the health workforce, integrate behavioral health into primary care, and expand access to care for people in high need communities, such as those who live rural areas, are exiting incarceration, have HIV, and youth with unmet behavioral health needs.

The successful recipient is expected to provide tailored technical assistance to State Medicaid Directors and other health care payment officials to address HRSA’s priorities and maximize the benefits of and potential collaborations with HRSA programs through:

• Communication and information sharing between HRSA and State Medicaid Directors and other health care payment officials, and

• Training; data collection, sharing, and analysis; convenings, (e.g., learning exchanges on priority topics); and other activities that enable State Medicaid Directors and other health care payment officials to operate in a responsive, coordinated, and effective manner.

Program Objectives

• Engage multiple states and their State Medicaid Directors and other health care payment officials to develop detailed implementation plans for policy initiatives that will improve access to quality health care for their highest-need populations that intersect with HRSA programs and HRSA settings of care. Where feasible, these initiatives can be shared across multiple states to achieve a nationwide impact.

• Implement technical assistance activities and tools on health care financing policies, models, and data strategies that will benefit State Medicaid Directors, State Medicaid programs, and HRSA grantees to improve access to quality health care for high need communities by leveraging both HRSA programs and State Medicaid programs.

For more details, see Program Requirements and Expectations.

2. Background

The NOSLO Program

HRSA-24-103 NOSLO 2

The NOSLO program is authorized by Section 311(a) of the Public Health Service (PHS) Act (42 USC §243(a)). This program has five funding tracks: 1) State and Local Public Health Systems, 2) State Health Legislative Education, 3) Health Policy Innovation, 4) State Health Services and Financing, and 5) State Governance. See Appendix A for detailed descriptions of the five tracks.

State Health Services and Financing Track

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to many low-income people, pregnant women, children, and individuals with disabilities, and is one of the largest payers for health care in the United States.

Many Medicaid and CHIP financing and coverage decisions occur at state and local levels. The NOSLO: State Health Services and Financing track award recipient facilitates a relationship between HRSA and state, territorial, tribal and local stakeholders.

HRSA’s mission is to improve health outcomes and achieve health equity through access to quality services, a skilled health workforce, and innovative, high-value programs. HRSA provides equitable health care to the nation’s highest-need communities, including rural areas. Nearly half of the over 30 million patients served by HRSA-supported health centers are enrolled in Medicaid. HRSA supports rural communities through its Federal Office of Rural Health Policy, and over 40 percent of all births in rural, non-metropolitan areas are paid for by Medicaid. Nearly every newborn in the country received screening through HRSA-administered maternal and child health programs, while approximately 41% of all births are covered by Medicaid. HRSA also leads health workforce development and training programs that connect skilled health care providers to communities in need – many members of which are covered by Medicaid – and increasingly funds training for primary care physicians, pediatricians, and others to address mental health and substance use disorder.

Medicaid and the Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage to people with low-income many low-income people, pregnant women, children, and individuals with disabilities, and is one of the largest payers for health care in the United States. Many Medicaid and CHIP financing and coverage decisions occur at state and local levels. The NOSLO: State Health Services and Financing track award recipient facilitates a relationship between HRSA and state, territorial, tribal, and local stakeholders.

Highly qualified applicants include national organizations that are knowledgeable about the needs of State Medicaid Directors and other health care payment officials, have a history of successfully building the capacity of State Medicaid Directors and other health care payment officials to preserve and improve health care services and public health, have existing communication platforms with a national reach, and have expertise and resources relevant to HRSA’s mission.

National organizations that represent state and territorial officials are uniquely positioned to respond to urgent and emergent public health needs, disseminate promising practices, identify challenges in the state, territorial, tribal, and local policy https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html/USCODE-2011-title42-chap6A-subchapII-partB-sec243.htm https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html/USCODE-2011-title42-chap6A-subchapII-partB-sec243.htm

HRSA-24-103 NOSLO 3

landscape that require attention, and experience developing high-quality policy analysis and policy-related research on health care financing, innovative care/payment models, and payment reform. They provide technical assistance to support officials and entities overseeing health care-related payment and related finance mechanisms. These officials and entities include Medicaid directors, insurance commissioners, state/territorial legislators, state/territorial/local public health departments, behavioral health officials, and health policy advisors.

NOSLO: State Health Services and Financing Track Performance Measures See Appendix B for the list of measures that HRSA will use to evaluate program performance.

II. Award Information

1. Type of Application and Award

Application type(s): New

We will fund you via a cooperative agreement.

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

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

• Collaborate with the award recipient to refine the Project Work Plan to address shared HRSA and Medicaid priorities and changes in the nation’s health care landscape.

• Review and support the development of key reports and other activities (i.e., data collection), including review of the publication plan and approval of reports and other specialized materials for general distribution prior to their publication.

• Monitor and support implementation of the Project Work Plan through collaborative meetings, monthly calls, quarterly and annual meetings, and progress report reviews.

• Coordinate efforts with the award recipient to identify and support collaboration across other NOSLO tracks and, if applicable, other relevant national, state, and/or local stakeholder organizations and similar HRSA programs as appropriate.

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

• Using the work plan matrix template provided in Appendix C, collaborate with the HRSA Project Officer on updating and implementing the Project Work Plan based on HRSA-identified priorities and changes in the health care landscape

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(e.g., the unwinding of expanded Medicaid coverage that was in place during the COVID-19 public health emergency).

• Participate in meetings, monthly calls, and progress report reviews to support the successful implementation of the Project Work Plan.

• Notify and collaborate with HRSA to update the Project Work Plan regularly; and remain flexible and responsive to emerging issues with health care financing (e.g., to revise current objectives or activities or establish new objectives or activities as needed).

• Collaborate with other NOSLO track award recipients, other relevant national, state, and/or local stakeholder organizations when requested, and coordinate with the HRSA Project Officers to collaborate with similar HRSA programs as appropriate.

• Consult with the HRSA Project Officer on dates for meetings, convenings, or conferences that pertain to the scope of work.

• Plan for HRSA leadership and staff to participate in NOSLO: State Health Services and Financing-funded convenings and other relevant events and/or conferences.

2. Summary of Funding

We estimate $500,000 will be available each year to fund one recipient. Work plans and budgets should be targeted to this level. You may apply for a ceiling amount of up to $500,000 annually (reflecting direct and indirect costs).

The period of performance is September 30, 2024, through September 29, 2027 (3 years).

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

Support beyond the first budget year will depend on:

• Appropriations

• Satisfactory progress in meeting the project’s objectives

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

Note: Additional funding may become available at HRSA’s discretion, but this is not guaranteed. Recipients may request supplemental funding at any point in their period of performance to address unique activities that are connected to, but not duplicative of, the funded scope of work. HRSA may choose to support such supplemental projects if funding is available and allocable, the request is reasonable and allowable, sufficient time remains in the budget period to approve the request, and the activities are aligned with HRSA priorities and are not duplicative of work performed by HRSA or other HRSA-funded recipients.

HRSA-24-103 NOSLO 5

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

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

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public or private, non-profit, or for-profit entities, including community-based organizations, tribal governments, and tribal organizations.

You can apply if your organization is in the United States, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau and is:

• Public or private, non-profit

• Community-based

• Native American tribal governments 12

• Include any proof of applicant status that you’ll require. For example, proof of non-profit status, in Section IV.2. with a cross-reference to this section, if it applies. Ensure that proof of applicant status is broad enough to include tribal governments’ and tribal organizations’ documentation.

Note: Current NOSLO award recipients are not eligible to apply as the primary recipient for NOSLO State Health Services and Financing Funding.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

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

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

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

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3. Other

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

• Exceeds the funding ceiling amount

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

Multiple Applications

Multiple applications from an organization for NOSLO: State Health Services and Financing are not allowed.

Note: No organization will receive more than one NOSLO award.

Applicants may apply to Grants.gov as many times as they want before the application deadline. The last application that Grants.gov verifies before the deadline will move forward.

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

IV. Application and Submission Information

1. Address to Request Application Package

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

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

Select “Subscribe” and enter your email address for HRSA-24-103 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 are responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

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

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

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

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

Eligibility Information of the NOFO.

These items do not count toward the page limit:

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

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

• Indirect Cost Rate Agreement

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

If there are other items that do not count toward the page limit, we’ll make this clear in Section IV.2.v Attachments.

If you use an OMB-approved form that is not in the HRSA-24-103 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-103 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals3 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.4

• If you cannot certify this, you must include an explanation in Attachment 8-15:

Other Relevant Documents.

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

Program Requirements and Expectations We expect that the award recipient funded under this notice will have the following:

• Ability to successfully communicate and engage with State Medicaid Directors and other health care payment officials nationwide.

• Organizational capacity to facilitate the relationship between HRSA and State Medicaid Directors and other health care payment officials through convenings and other engagements.

• Expertise and experience in providing capacity-building support at the national and state levels, including a history of successfully engaging with State Medicaid

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

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

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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Directors and other health care payment officials to preserve and improve public health.

• Experience building relationships with, and knowledge of the needs of, State Medicaid Directors and other health care payment officials.

• Demonstrated comprehensive understanding of the health services and public health landscape to effectively respond to emergent issues and trends.

The award recipient should address activities proposed over the course of the three-year project period. The recipient may propose multi-year activities or new activities each year of the project. By the end of Year 1, the successful award recipient is expected to have:

• Developed a detailed workplan and outreach strategy with HRSA’s input.

• Convened State Medicaid Directors, other health care payment officials, HRSA, and key stakeholder organizations to select project priorities that will improve access to quality health care for the populations HRSA serves and are responsive to states’ needs and priorities by leveraging HRSA programs and state Medicaid programs; and

• Developed and implemented technical assistance plans that include convenings and products that address the states’ needs related to improved access to quality health care for their highest need communities.

Core Activities The NOSLO: State Health Services and Financing cooperative agreement is designed to be flexible and address the priorities and areas of intersection between HRSA, State Medicaid Directors, State Medicaid programs, other health care payment officials, and key stakeholder organizations. The award recipient may use the funds to establish entirely new initiatives or to build on ongoing efforts, i.e., to build on and supplement ongoing programs and activities, such as policy initiatives driven by organizational leadership and/or membership, or training programs for new State Medicaid Directors and other health care payment officials.

The successful NOSLO: State Health Services and Financing award recipient is expected to:

A. Analyze policy. Develop, implement, and evaluate policy or other initiatives related to priority topics in collaboration with participating states and HRSA;

B. Convene stakeholders. Convene State Medicaid Directors and other health care payment officials, HRSA, and other key stakeholders at least once a year to share best practices, strategize and align efforts on work towards achieving shared goals;

C. Develop rapid responses. Respond to “Rapid Response” information requests under short timeframes on urgent topics to gain insight from the field. The award recipient is expected to dedicate 5% of the budget to responding to these ad-hoc

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“Rapid Response” information requests from HRSA about state and local trends and policy development on critical public health topics;

D. Provide technical assistance and product development. Provide capacity development activities and effective tools and strategies for ongoing outreach, collaborations, clear communication, and information sharing/dissemination with State Medicaid Directors and other health care payment officials, HRSA, and public health stakeholders;

E. Plan for sustainability of products. Develop a plan to make NOSLO: State Health Services and Financing capacity-building resources publicly available after the period of performance ends.

Priority Topic Selection The award recipient should select topics from the list below that will improve access to quality health care for the populations HRSA serves and are responsive to states’ needs and priorities. Where feasible, topics should reach states across the country to achieve a nationwide impact.

Applicants are encouraged to address HHS and HRSA priorities as they relate to State Medicaid Directors and other health care payment officials. The award recipient is strongly encouraged to include one or more of the following public health priorities as a focus of their projects:

• Health collaboration and planning at the state level, including Medicaid offices, on topics such as Medicaid reimbursement/coverage for the community-based workforce (e.g., community-based doulas, peer specialists, and community health workers) and HRSA’s investment in training the community workforce;

• Access to maternal care, growing the maternal care workforce, supporting maternal mental health, and addressing the important social supports that are vital to safe pregnancies.

• Strategies to strengthen coordination between HRSA-supported grantees, including HRSA-supported health centers, workforce grantees, and Medicaid, including Medicaid managed care;

• Support services or wraparound services (e.g., transportation) and models for underserved populations that are Medicaid-eligible;

• Strategies to expand Medicaid pre-release services for incarcerated populations and connect people leaving the criminal justice system to Medicaid coverage and services, including through HRSA-funded programs, focusing on medications for opioid use disorder and supports for people with substance use disorders;

• Other emerging priorities as identified by the applicant.

Note: Priorities for focus are anticipated to change over the course of the three-year project period.

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HRSA recognizes that there are a variety of models to use when engaging with states and is, therefore, not requiring the award recipient to follow a particular model. Some examples include, but are not limited to:

• Developing cross-discipline teams or affinity groups;

• Convening forums such as policy academies and learning collaboratives to engage in peer-to-peer learning and/or work through a problem;

• Developing state action plans; or

• Developing learning networks.

You may propose joint projects with other applicants in your application; however, a letter of support and commitment is required from each proposed partner (Attachment 4).

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

i. Project Abstract

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

NARRATIVE GUIDANCE

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

Narrative Section Review Criteria

Introduction Criterion 1: NEED AND PURPOSE

Organizational Information Criterion 3: EVALUATIVE MEASURES

Criterion 5: RESOURCES/CAPABILITIES

Need Criterion 1: NEED AND PURPOSE

Approach Criterion 2: RESPONSE

Criterion 4: IMPACT

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Narrative Section Review Criteria

Work Plan Criterion 2: RESPONSE

Criterion 3: EVALUATIVE MEASURES

Criterion 4: IMPACT

Criterion 6: SUPPORT REQUESTED

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES

Criterion 4: IMPACT

Criterion 5: RESOURCES/CAPABILITIES

Budget Narrative Criterion 6: SUPPORT REQUESTED – the budget section should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

ii. Project Narrative

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

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

This ensures reviewers can understand your proposed project.

Introduction -- Corresponds to Section V’s Review Criterion 1: NEED AND

PURPOSE

Briefly describe the purpose of the proposed work. Briefly discuss your organization’s target audience, your constituents’ need for capacity-building activities, your proposed response to that need, and how you will enhance collaboration and communication between HRSA, HRSA programs and grantees, and State Medicaid Directors and other health care payment officials.

Organizational Information -- Corresponds to Section V’s Review Criterion 3 EVALUATIVE MEASURES and 5 RESOURCES/CAPABILITIES Organizational Resources

1. Describe how your organization currently provides capacity-building assistance to support and disseminate best practices among State Medicaid Directors and other health care payment officials. Demonstrate a strong history of developing and disseminating capacity-building activities to State Medicaid Directors and other health care payment officials nationwide.

2. List the products (e.g., e-newsletters, website platforms) your organization uses to communicate information to State Medicaid Directors and other health care payment officials.

HRSA-24-103 NOSLO 12

3. List the major meetings and events your organization typically holds for State Medicaid Directors and other health care payment officials throughout the year, with the number of attendees per meeting/event. Indicate opportunities to incorporate NOSLO: State Health Services and Financing activities and HRSA staff into these meetings/events.

4. List and describe the data that you collect on State Medicaid Directors and other health care payment officials, including how you identify promising practices, needs, priorities, and relevant issues. Indicate whether the data are publicly available and, if not, whether your organization will share the data with HRSA upon request. Discuss how you can leverage this data to collaborate with HRSA quickly and effectively when urgent, emergent, and/or priority issues arise.

Organizational Structure, Staffing, and Project Management

1. Provide a brief overview of the history of your organization. Include your mission and structure (consistent with Attachment 5: Organizational Chart) and the scope of your current activities.

2. Describe how your organizational structure, including your organization’s management team (e.g., Chief Financial Officer, Project Director) and any contracts or agreements, is appropriate for the operational and oversight needs of this project.

3. Describe your organization’s financial accounting and internal control systems and how they, as well as related policies and procedures, will reflect Generally Accepted Accounting Principles.5

4. Discuss the systems and processes that will support your organization's performance management requirements, including a description of your data systems, data management software, and staff with expertise in data collection, data analysis, data reporting, and data management.

5. Provide a proposed staffing plan (consistent with Attachment 2: Staffing Plan and Job Descriptions for Key Personnel). Define all roles and demonstrate why the plan is appropriate for the number and variety of activities to be provided during the period of performance. Include information on how you will recruit and/or retain staff to achieve or maintain the proposed staffing plan.

6. Describe the training, experience, skills, and subject matter expertise of individuals in the roles defined in the proposed staffing plan (consistent with Attachment 3: Biographical Sketches of Key Personnel). If applicable, describe recent changes in key management staff or significant changes in roles and responsibilities.

3 GAAP are used as defined in HHS Grants Policies and Regulations 45CFR Part 75.

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7. Describe how you will ensure that you initiate the proposed activities for Year 1 within 60 days of award by documenting that appropriate staff will be in place. Provide a timeline for hiring, onboarding, and staff development, as needed.

8. Describe past performance managing collaborative federal awards at the national level, including examples of the extent to which measurable accomplishments were completed in full and on time.

Need-- Corresponds to Section V’s Review Criterion 1 NEED AND PURPOSE Describe your stakeholders and outline their needs. Be specific and cite data to the extent possible in your response. Data used to complete this section should be from appropriate sources and reflect the most recent timeframe available. Data collected by your organization (e.g., stakeholder surveys, internal records) are an acceptable source, but provide details about the methodology and sample size.

Discuss how state-level policies affect access to quality health care for the population(s) your project work will address and the role your organization and your organization’s key stakeholders play in affecting state policies impacting access to quality health care for this population(s). Please discuss any relevant barriers that the project(s) hopes to overcome.

Reach and Membership

1. Create a table (example below) that depicts the categories of officials served by your organization, the number of officials served in each category, and the percentage of officials your organization reaches in each category. For example, if your organization represents county and local health departments, provide the percentage of county and local health departments your organization serves out of the total number of county and local health departments in the U.S.

Categories of Officials Served

Total Number of Officials Served Per Category

Percentage of Population Served Per Category

State/Territorial Legislators

X X%

State Medicaid Directors X X% State CHIP Directors X X% Behavioral Health Officials

X X%

Governors’ Health Policy Officials

X X%

Cabinet-Level Health Policy Officials

X X%

Other (specify) X X%

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2. Provide evidence that your organization has a national reach regarding relationships with and impact upon the officials discussed above and is not a partisan organization.

Alignment of Stakeholder Needs, Organizational Expertise, and HRSA Priorities

1. Describe your target audience’s priority issues, unmet capacity-building assistance needs, and any relevant barriers to capacity-building assistance that you hope to overcome through this funding.

2. Outline and prioritize the short-term (<1 year) and medium-term (2-3 years) capacity-building needs of your target audience.

3. Identify the HRSA-related programs, key issues, and populations that are currently of the most interest to your stakeholders.

Approach -- Corresponds to Section V’s Review Criterion 2 RESPONSE and 4

IMPACT

Referencing the Core Activities, use the following headings as you complete the Approach section:

For Core Activity A (Analyze policy. Develop, implement, and evaluate policy or other initiatives related to priority topics in collaboration with participating states and HRSA), describe how you will work with participating states and HRSA to develop, implement, and evaluate policy or other initiatives related to priority topics.

For Core Activity B (Convene stakeholders. Convene State Medicaid Directors and other health care payment officials, HRSA, and other key stakeholders, including public and private sector organizations, at least once a year to share best practices, strategize, and align efforts on work towards achieving shared goals), describe how you would arrange a forum (e.g., as part of an annual meeting) for participants described above to share best practices, strategize, and align efforts on work towards achieving shared goals.

For Core Activity C (Develop rapid responses. Respond to “Rapid Response” information requests under short timeframes on urgent topics to gain insight from the field. The award recipient is expected to dedicate 5% of the budget to responding to these ad-hoc “Rapid Response” information requests from HRSA about state and local trends and policy development on critical public health topics), describe how you will respond to ad-hoc Rapid Response information requests from HRSA.

For Core Activity D (Provide technical assistance and product development.

Provide capacity development activities and effective tools (e.g., publications, products, tools, webinars, and other resources) and strategies for ongoing outreach, collaborations, clear communication, and information sharing/dissemination with State Medicaid Directors and other health care payment officials, HRSA, and public health stakeholders), describe:

HRSA-24-103 NOSLO 15

1. The types of capacity development activities and effective tools you would develop and disseminate to support effective implementation of the policy initiatives and best practices. Explain why you believe those strategies would be effective.

2. The tools and strategies you will use for ongoing outreach, collaborations, clear communication, and information sharing/dissemination about state needs, policies, and priority areas for State Medicaid Directors and other healthcare payment officials with HRSA and health stakeholders. Be sure to discuss any limitations you may face around information sharing.

3. How you will share information about HRSA programs and initiatives with State Medicaid Directors and other healthcare payment officials.

4. How you will create opportunities for State Medicaid Directors and other healthcare payment officials to engage with HRSA, HRSA programs and grantees, and/or other federal staff to align efforts on work towards achieving shared goals to strengthen the health care safety net.

For Core Activity E (Plan for sustainability of products. Develop a plan to make NOSLO: State Health Services and Financing capacity-building resources publicly available after the period of performance ends), describe how you will promote sustainability of project activities so that they continue to have an impact on State Medicaid Directors and other healthcare payment officials. Also describe how you will make NOSLO: State Health Services and Financing capacity-building resources publicly available after the period of performance ends.

Work Plan -- Corresponds to Section V’s Review Criterion 2 RESPONSE, 3 EVALUATIVE MEASURES, 4 IMPACT, and 6 SUPPORT REQUESTED Work Plan Matrix

Submit a three-year work plan matrix (as Attachment 1) for the three-year period of performance using the template provided in Appendix C. The matrix should contain the following elements for each proposed activity within the Core Activities including expected year 1 activities:

• Activity description.

• Responsible individual(s).

• Timeline (e.g., start date, milestones, completion date).

• HRSA settings of care/program that the activity will impact or amplify.

• Expected outcomes and impact.

• Proposed performance measures for outputs and outcomes/impact (<1 year;

at the end of the period of performance; after the period of performance).

• Proposed data source for performance measures.

• Target goals.

The Budget Narrative should reflect the strategies described in this work plan.

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Work Plan Narrative

In addition to the matrix, answer the following questions in narrative form.

1. Describe how you will implement proposed activities, including how you will evolve and/or add new activities in Years 2 and 3 of the period of performance to achieve the stated milestones and target goals by the end of each year.

2. Address priority selection and project development, including outlining:

a. How you will convene State Medicaid Directors, other health care payment officials, HRSA, and key stakeholder organizations to select project priorities that will improve access to quality health care for the populations HRSA serves and are responsive to states’ needs and priorities; and

b. How you will develop and implement technical assistance plans that include convenings and products that address the states’ needs related to improved access to quality health care for their highest-need communities.

3. Provide evidence of how the proposed activities address the needs identified in the “Need” section.

Resolution of Challenges -- Corresponds to Section V’s Review Criterion 2

RESPONSE

1. Describe any potential obstacles for implementing program performance evaluations and your plan to address those obstacles.

2. Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and outline approaches you will use to overcome such challenges. Include current or anticipated national, state, or local initiatives that may impact milestone and target goal attainment, affect performance measurement, or result in the need to adjust planned activities.

Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review Criterion 3 EVALUATIVE MEASURES, 4 IMPACT, and 5

RESOURCES/CAPABILITIES

1. Identify and explain your strategy to collect, analyze and track data to measure progress toward the target goals listed in the “Core Activities” section and to fulfill performance measure reporting requirements (see Appendix B).

2. Describe how you will share your evaluation results with HRSA and be responsive to HRSA’s evaluation efforts.

bookmark://COREACTIVITIES/ bookmark://Appendix_B/

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iii. Budget

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

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

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

Program Income

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

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), Division H, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2024, the salary rate limitation is $221,900. As required by law, salary rate limitations may apply in future years and will be updated.

iv. Budget Narrative

See Section 4.1.v. of the Application Guide.

v. Attachments

Provide the following attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) are the only exceptions. They will not count toward the page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to.

Attachment 1: Work Plan Matrix (Required)

Attach the project’s work plan matrix (see Appendix C). Make sure it includes everything that Section IV.2.ii. Project Narrative details. If you’ll make subawards or spend funds on contracts, describe how your organization will document funds.

Attachment 2: Staffing Plan and Job Descriptions for Key Personnel (see Section 4.1. of the Application Guide)

Keep each job description to one page as much as possible. Include the role, responsibilities, and qualifications of proposed project staff. Describe your https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://www.congress.gov/bill/117th-congress/house-bill/2617/text

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organization’s timekeeping process. This ensures that you’ll comply with federal standards related to recording personnel costs.

Attachment 3: Biographical Sketches of Key Personnel (Required) (Do count towards the page limit) Include biographical sketches for people who will hold the key positions you describe in Attachment 2. Keep it to two pages or less per person. Do not include personally identifiable information (PII). If you include someone you have not hired yet, include a letter of commitment from that person with the biographical sketch.

Attachment 4: Letters of Agreement, Memoranda of Understanding (as required to document eligibility)

Provide any documents that describe working relationships between your organization and other entities and programs you cite in the proposal. Documents that confirm actual or pending contracts or agreements should clearly describe the roles of the contractors and any deliverable. Make sure you sign and date any letters of agreement. If letters of support are required for eligibility, include in this attachment.

Attachment 5: Project Organizational Chart (Required)

Provide a one-page figure that shows the project’s organizational structure.

Attachment 6: Indirect Cost Rate Agreement if applicable (Not counted in the page limit)

Submit a copy of your most recently approved IDC rate agreement, which supports the indirect cost rate requested in the application budget.

Attachment 7: Proof of Non-profit Status if applicable (Does not count towards the page limit)

If your organization is a non-profit, you need to attach proof. We will accept any of the following:

• A copy of a current tax exemption certificate from the IRS.

• A letter from your state's tax department, attorney general, or another state official saying that your group is a non-profit and that none of your net earnings go to private shareholders or others.

• A certified copy of your certificate of incorporation. This document must show that your group is a non-profit.

• Any of the above for a parent organization. Also include a statement signed by an official of the parent group that your organization is a non-profit affiliate.

• [other attachments]

Attachments 8–15: Other Relevant Documents (no more than 15)

Include any other documents that are relevant to the application. This may include letters of support. Letters of support must be dated and show a commitment to the project/program (in-kind services, dollars, staff, space, equipment, etc.).

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3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

A UEI is required to apply for this funding. You must register in the SAM.gov to receive your UEI.

You cannot use a DUNS number to apply. For more details, visit the following webpage:

General Service Administration’s UEI Update

After you…