OAT HRSA-24-010 (UL8) BHI EBTNP FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Office for the Advancement of Telehealth Telehealth Innovation and Services Division

Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program (EB-TNP)

Funding Opportunity Number: HRSA-24-010

Funding Opportunity Type(s): New

Assistance Listings Number: 93.211

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

We will not approve deadline extensions for lack of registration.

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

Issuance Date: January 2, 2024

Carlos Mena, MS Public Health Analyst, Office for the Advancement of Telehealth Phone: (301) 443-3198 Email: cmena@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 254c-14(d)(1) (§ 330I(d)(1) of the Public Health Service Act) mailto:cmena@hrsa.gov

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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: Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program (EB-TNP)

Funding Opportunity Number: HRSA-24-010

Assistance Listing Number: 93.211

Due Date for Applications: March 22, 2024

Purpose: The purpose of this program is to integrate behavioral health services into primary care settings using telehealth technology through telehealth networks and evaluate the effectiveness of such integration.

Program Objective(s): Support evidence-based projects that utilize telehealth technologies through telehealth networks in rural and underserved areas to:

(A) improve access to integrated behavioral health services in primary care settings; and

(B) expand and improve the quality of health information available to health care providers by evaluating the effectiveness of integrating telebehavioral health services into primary care settings and establishing an evidence-based model that can assist health care providers.

Eligible Applicants: Eligible applicants shall be domestic public or private, non-profit or for-profit entities t h a t demonstrate that they will provide services through a telehealth network. This includes faith-based, tribal and community-based 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:

$8,750,000

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

Estimated Number and Type of Award(s):

Up to 25 cooperative agreement(s)

Estimated Annual Award Amount:

Up to $350,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: September 1, 2024 through August 31, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

Contact Name: Shelia Burks Grants Management Specialist Division of Grants Management Operations, OFAM Email: sburks@hrsa.gov

Program issues or technical assistance:

Carlos Mena, MS Public Health Analyst Attn: Office for the Advancement of Telehealth Health Resources and Services Administration 5600 Fishers Lane, Room 17W Rockville, MD 20857 Telephone: (301) 443-3198 Email: cmena@hrsa.gov mailto:sburks@hrsa.gov

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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.

Technical Assistance

We have scheduled the following webinar:

Wednesday, January 17, 2024 3:30 – 4:30 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1605850194?pwd=YVYxMU5lcGl0SnR1bXZ6VjVvTFpVQT09

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

Call-In Number: 1-833-568-8864 Meeting ID: 160 585 0194 Passcode: 47535161

We will record the webinar. Please contact cmena@hrsa.gov to request playback information 48 hours after the live event.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1605850194?pwd=YVYxMU5lcGl0SnR1bXZ6VjVvTFpVQT09 https://hrsa-gov.zoomgov.com/j/1605850194?pwd=YVYxMU5lcGl0SnR1bXZ6VjVvTFpVQT09

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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

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: COMMON DEFINITIONS

APPENDIX B: USEFUL RESOURCES

APPENDIX C: PAGE LIMIT WORKSHEET

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program (EB-TNP). The purpose of this program is to integrate behavioral health services into primary care settings using telehealth technology through telehealth networks and evaluate the effectiveness of such integration.

The goal for the BHI/EB-TNP Program is to support evidence-based projects that utilize telehealth technologies through telehealth networks in rural and underserved areas1 (i.e., rural areas that are also frontier communities, medically underserved areas, or have medically underserved populations), to:

(1) improve access to integrated behavioral health services in primary care settings; and

(2) expand and improve the quality of health information available to health care providers by evaluating the effectiveness of integrating telebehavioral health services into primary care settings and establishing an evidence-based model that can assist health care providers.

Applicants are encouraged to propose novel ways to achieve equity in access to affordable, high-quality, culturally and linguistically appropriate telebehavioral care for rural and underserved patients across the U.S. Through this opportunity, HRSA aims to support innovative integration strategies of telebehavioral health into primary care settings that serve rural and underserved communities with high needs for such services. As a result, applicants must propose to provide telebehavioral health services to patients in rural and underserved areas. Applicants are strongly encouraged to propose established telehealth networks to provide telebehavioral health services which are integrated into the primary care for populations with disparate challenges to quickly and efficiently provide telebehavioral health services to them.

Program results will include generating data to inform research activities; expanding telebehavioral health services to rural and underserved communities and primary care settings; increasing the capacity of existing telehealth networks, and developing innovative strategies, methods, or tools, to integrate telebehavioral health services into primary care settings.

For more details, see Program Requirements and Expectations.

1 Rural Health Information Hub (RHIhub). What is Rural? https://www.ruralhealthinfo.org/topics/what-is-rural

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2. Background

The Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program (EB-TNP) is authorized by section 330I(d)(1) of the Public Health Service Act (42 USC §254c-14(d)(1)).

The Office for the Advancement of Telehealth (OAT) is located within the Health Resources and Services Administration (HRSA) and supports a wide range of telehealth activities, including this funding opportunity. HRSA defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.2

Telehealth has grown in the United States since the beginning of the COVID-19 pandemic and will remain an integral part of medical care.3 Yet, behavioral health care providers are in short supply throughout the United States, and even more so in rural areas.4 In September 2022, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) published an Issue Brief entitled “HHS Roadmap for Behavioral Health Integration”.5 The issue brief states that “in 2020, the past-year prevalence of any mental illness among adults in the United States (U.S.) was 21%, meaning that

52.9 million adults were affected by mental illness.” Integrated care generally aims to treat the whole person’s health care needs in a coordinated way that improves health outcomes. Rural residents are at a higher risk to behavioral health disparities that include distance challenges in getting to healthcare facilities, lower rates of insured patients, higher rates of poverty, and lower education and health literacy rates.6 While lack of insurance coverage is one of the more quantifiable factors in access to care, other factors also persist as key impediments to care. Examples include stigma; past experiences of discrimination when receiving health care, lack of accessible, culturally and linguistically competent providers in one’s community; and other unmet social needs (e.g., transportation, childcare coverage).

2 https://www.hrsa.gov/rural-health/topics/telehealth/what-is-telehealth 3 Shaver, Julia. The State of Telehealth Before and After the COVID-19 Pandemic. Primary Care: Clinics in Office Practice. Dec. 2022: 49(4): 517-530. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035352/. Accessed 4/7/2023.

4 Ward MM, Carter KD, Bhagianadh D, Ullrich F, Merchant KA, Marcin JP, Law KB, McCord C, Neufeld J, Nelson EL, Shane DM. Comparison of telehealth and in-person behavioral health services and payment in a large rural multisite usual care study. Telemedicine and e-Health. April 10, 2023. Accessed 5/26/23.

5 U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE). (2022).

HHS Roadmap for behavioral health integration.

https://aspe.hhs.gov/sites/default/files/documents/4e2fff45d3f5706d35326b320ed842b3/roadmap-behavioral-health-integration.pdf 6 McCord C, Ullrich F, Merchant KAS, Bhagianadh D, Carter KD, Nelson E, Marcin JP, Law KB, Neufeld J, Giovanetti A, Ward MM. Comparison of in-person vs. telebehavioral health outcomes from rural populations across America.

BMC Psychiatry 22, 778 (2022). https://doi.org/10.1186/s12888-022-04421-0. Accessed 6/2/23.

https://www.hrsa.gov/rural-health/topics/telehealth/what-is-telehealth https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035352/ https://aspe.hhs.gov/sites/default/files/documents/4e2fff45d3f5706d35326b320ed842b3/roadmap-behavioral-health-integration.pdf https://aspe.hhs.gov/sites/default/files/documents/4e2fff45d3f5706d35326b320ed842b3/roadmap-behavioral-health-integration.pdf https://doi.org/10.1186/s12888-022-04421-0

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Integrating behavioral health into primary care can help to address health equity and provide a collaborative, patient-centered, and whole-person care approach.7 Applicants are encouraged to include populations that have historically suffered from poorer health outcomes, health disparities, and other inequities when addressing behavioral health care needs. Examples of these populations include, but are not limited to, racial and ethnic minorities, person/persons in geographically isolated areas, person/persons experiencing homelessness, pregnant women, disabled individuals, youth and adolescents, etc.

State Medicaid agencies are an important partner in improving access to and delivery of telebehavioral services in rural areas. In June 2022, the Medicaid and CHIP Payment and Access Commission (MACPAC) Report to Congress recommended CMS issue guidance to help states use Medicaid authorities and other federal resources to promote behavioral health Information Technology (IT) adoption and that the Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration work together to develop a voluntary certification to encourage health IT uptake appropriate for behavioral health.8

Applicants are strongly encouraged to pursue and adopt a promising practice model that can demonstrate positive health outcomes for their targeted rural and underserved communities. Examples of such models include, but are not limited to, the American Psychological Association’s Primary Care Behavioral Health Model (PCHB) and Collaborative Care Model (CoCM)9 and the American Academy of Family Physicians’ GATHER (generalist, accessible, team-based, high productivity, education, and routine) Behavioral Health Integration Model.10 You must base your proposed project on established practices.

Applicants are encouraged to work with your National and Regional Telehealth Resource Center to identify best or promising practices in effectively integrating your proposed project into your existing health care practice. Applicants are also encouraged to visit the HHS Telehealth website, to find resources and best practices for providers.

In addition, applicants may visit the HRSA Training and Technical Assistance Hub website, which houses all HRSA training and technical assistance resources to extend the reach of our training and technical assistance resources and further the impact of

7 Agency for Healthcare Research and Quality. Health Equity and Behavioral Health Integration.

https://integrationacademy.ahrq.gov/products/topic-briefs/health-equity. Accessed on 9/14/23.

8 Medicaid and CHIP Payment and Access Commission (MACPAC). (2022). Report to Congress on Medicaid and CHIP. https://www.macpac.gov/wp-content/uploads/2022/06/MACPAC_June2022-WEB-Full-Booklet_FINAL-508- 1.pdf 9 American Psychological Association (APA). (June 2022). Behavioral Health Integration Fact Sheet.

https://www.apa.org/health/behavioral-integration-fact-sheet 10 Schrager, S. Integrating Behavioral Health Into Primary Care. Fam Pract Manag. 2021;28(3):3-4.

https://www.aafp.org/pubs/fpm/issues/2021/0500/p3.html#fpm20210500p3-ut1. Accessed on 9/13/23.

https://www.apa.org/health/behavioral-integration-fact-sheet https://www.apa.org/health/behavioral-integration-fact-sheet https://www.aafp.org/pubs/fpm/issues/2021/0500/p3.html#fpm20210500p3-ut1 https://www.aafp.org/pubs/fpm/issues/2021/0500/p3.html#fpm20210500p3-ut1 http://www.telehealthresourcecenter.org/ http://www.telehealthresourcecenter.org/ http://www.telehealth.hhs.gov/ http://www.telehealth.hhs.gov/ https://www.hrsa.gov/library/index.html https://www.hrsa.gov/library/index.html https://integrationacademy.ahrq.gov/products/topic-briefs/health-equity https://www.macpac.gov/wp-content/uploads/2022/06/MACPAC_June2022-WEB-Full-Booklet_FINAL-508-1.pdf https://www.macpac.gov/wp-content/uploads/2022/06/MACPAC_June2022-WEB-Full-Booklet_FINAL-508-1.pdf https://www.apa.org/health/behavioral-integration-fact-sheet https://www.aafp.org/pubs/fpm/issues/2021/0500/p3.html#fpm20210500p3-ut1

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HRSA award recipients and stakeholders. Resources are organized by topic and some resources may be listed under multiple topics.

All award recipients will have the opportunity to work closely with technical assistance (TA) providers throughout the five-year period of performance. The targeted TA will assist award recipients with achieving desired project outcomes, sustainability and strategic planning, and will ensure alignment of the awarded project with the BHI/EB- TNP Program goals. The TA is provided to award recipients at no additional cost. This support is an investment made by HRSA in order to ensure the success of the awarded projects. HRSA has found that most award recipients benefit greatly from the support provided through these collaborations. If funded, award recipients will learn more about the targeted technical assistance and evaluation support. Award recipients will also be required to work with the Telehealth-Focused Rural Health Research Center during the period of performance to develop evaluation measures to collect patient-level evidence-based data.

II. Award Information

1. Type of Application and Award

Application type(s): New

We will fund you through 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:

• Reviewing and providing recommendations on the final work plan;

• Ongoing review of award activities and input on content or approach;

• Participating in conference calls or meetings with the award recipients;

• Supporting collaboration between the BHI/EB-TNP program award recipients and the Telehealth-Focused Rural Health Research Center award recipient;

• Providing common measures that must be reported by all recipients;

• Reviewing products or publications before dissemination;

• Reviewing reimbursement requests for telehealth services that cannot be reimbursed by third party payers; and

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• Reviewing and providing recommendations regarding additional uses of the telehealth beyond telebehavioral health integration services. This may include using related telehealth technologies for provider education, or to provide clinical services for patients, beyond the award’s primary focus of care.

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

• Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the Application Guide (Acknowledgement of Federal Funding Summary of Funding)

• Completing activities included in the final approved work plan, including data collection on measures identified by HRSA and sharing aggregate data.

• Ensuring cooperative agreement activities contribute to establishing the evidence-base for integrating telebehavioral health services into primary care.

• Analyzing the integration of behavioral health services into primary care settings under common metrics and protocols that will allow for a multi-site analysis of the effectiveness of those services.

• Participating in conference calls or meetings with HRSA and technical assistance provider.

• Collaborating with telehealth and primary care stakeholders.

• Collaborating, if feasible, with entities that: (1) are private or public organizations that receive Federal or State assistance; or are public or private entities that operate centers, or carry out programs, that receive Federal or State assistance;

and (2) provide telehealth services or related activities.

• Engaging in webinars presented by TA providers (e.g., program best practices, sustainability).

• Identifying professional opportunities to present, exhibit, or publish program findings that contribute to the telehealth evidence-base.

• Collaborating with HRSA in ongoing review of activities and budgets; and

• Responding timely to requests for information, including requests for data submissions, from HRSA or the Telehealth-Focused Rural Health Research Center award recipient.

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2. Summary of Funding

We estimate approximately $8,750,000 to be available annually to fund up to 25 recipients. You may apply for a ceiling amount of up to $350,000 annually (reflecting direct and indirect costs).

The period of performance is September 1, 2024, through August 31, 2029 (5 years).

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

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives.

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

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

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

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

III. Eligibility Information

1. Eligible Applicants

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

• public or private, non-profit or for-profit entity

• Domestic faith-based or community-based organization

• Tribal (governments, organizations)

You can be located in an urban area, but your proposed telehealth network must include at least two originating sites located in rural and underserved areas.

A. Geographic Requirements:

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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Telehealth services have an originating site and a distant site. The originating site is the location where a patient gets physician or practitioner medical services through telehealth. A distant site is the location where a physician or practitioner provides telehealth. HRSA acknowledges the temporary Medicare11 and Medicaid12 policy changes in place for an originating site and a distant site.

You can use funds under this notice for an originating site only if the originating site is located in a rural and underserved area (i.e., a rural area that is also a frontier community, medically underserved area, or has a medically underserved population). Originating sites in rural areas that are not also either frontier communities, medically underserved areas, or have medically underserved populations, may not be funded through this award. Originating sites in urban areas may not be funded through this award. You can use funds under this notice for any distant site, regardless of location.

To determine whether a site is located in a rural and underserved area, please refer to the HRSA supported Rural Health Information Hub – Am I Rural? Tool (“RHIhub Tool”). This webpage allows you to search by county or street address.

Specifically:

• A site is located in a rural area if the RHIhub Tool indicates that it is in a Federal Office of Rural Health Policy (FORHP) defined rural area (a non-metropolitan county or in a rural census tract of a metropolitan county).

• A site is located in a frontier community if the RHIhub Tool indicates that it is in a Frontier and/or Remote area.

• A site is located in a medically underserved area if the RHIhub Tool indicates that it is in a Medically Underserved Area (MUA) or a Medically Underserved Area - Governor's Exception (MUA-GE).

• A site has a medically underserved population if the RHIhub Tool indicates that it has a Medically Underserved Population (MUP) or a Medically Underserved Population - Governor's Exception (MUP-GE).

B. Composition of the Telehealth Network:

To be eligible for award, you must demonstrate that you will provide services through a telehealth network. Each entity participating in the telehealth network may

11 Centers for Medicare and & Medicaid Services (June 2023). Medicare Learning Network Fact Sheet.

https://www.cms.gov/f iles/document/mln901705-telehealth-services.pdf 12 Center for Connected Health Policy (Spring 2023). State Telehealth Laws and Reimbursement Policies. https://www.cchpca.org/2023/05/Spring2023_SummaryChart.pdf https://www.ruralhealthinfo.org/am-i-rural https://www.cchpca.org/2023/05/Spring2023_SummaryChart.pdf

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be a nonprofit or for-profit entity. The telehealth network must be composed of at least one (1) Distant site, and at least two of the following entities as Originating sites (at least one of the two required originating sites must be a community-based health care provider, and both required originating sites must be located in rural and underserved areas):

a. Community or migrant health centers or other Federally Qualified Health Centers.

b. Health care providers, including pharmacists, in private practice.

c. Entities operating clinics, including Rural Health Clinics.

d. Local health departments.

e. Nonprofit hospitals, including Critical Access Hospitals.

f. Other publicly funded health or social service agencies.

g. Long-term care providers.

h. Providers of health care services in the home.

i. Providers of outpatient mental health services and substance use disorder services and entities operating outpatient mental health and substance use disorder facilities.

j. Local or regional emergency health care providers.

k. Institutions of higher education.

l. Entities operating dental clinics.

m. Providers of prenatal, labor care, birthing, and postpartum care services, including hospitals that operate obstetric care units.

The applicant organization must participate in the network, and all participants must be separately owned domestic entities. For purposes of this award, HRSA recognizes a growing trend towards greater consolidation within the rural health care industry and the possibility that multiple organizations with the same EIN and/or DUNS number could be located in different rural and underserved areas that have a need for telehealth services.

2. Cost Sharing or Matching

Cost sharing or matching not required for this program.

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 https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center

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Current Telehealth Network Grantees:

Current and former Telehealth Network Grant Program and Evidence Based Telehealth Network Program recipients are eligible to apply for funds through this notice for the FY 2024 cycle if the proposed project is a new proposal (entirely new project) or an expansion or enhancement of the previous award. The proposal should differ from the previous projects by expanding the service area of the project, serving a new population, providing a new service or expanding the scope of the previous award activities. If an applicant was previously funded through the Telehealth Network Grant Program or Evidence Based Telehealth Network Program, then the new BHI/EB-TNP Program proposed project should not supplant an existing project.

Applicants must submit abstracts from the previous Telehealth Network Grant Program and Evidence Based Telehealth Network Program award in Attachment 10.

State Rural Health Resources

Applicants are required to consult their State Office of Rural Health (SORH) or other appropriate state entity prior to submitting your application. The SORH may be able to provide consultation by sharing regarding model programs, data resources, and technical assistance for consortiums, evaluation, partner organizations, or support of information dissemination activities.

Multiple Applications

You may submit multiple applications under the same Unique Entity Identifier (UEI) if each proposes distinct projects. We will only review your last validated application for each distinct project before the Grants.gov due date. For example, if an organization has multiple geographic locations where clinical services are provided, the organization could come for funding for multiple site as long as there is no overlap of services being delivered. 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-24-010 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html

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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.

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

Eligibility Information of the NOFO.

These items do not count toward the page limit:

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

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

• Indirect Cost Rate Agreement

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

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

If you use an OMB-approved form that is not in the HRSA-24-010 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-010 before the deadline.

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals13 (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.14

• If you cannot certify this, you must include an explanation in Attachment 13:

Other Relevant Documents.

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

Program Requirements and Expectations

Award recipients will be required to work with a HRSA-funded technical assistance provider and Telehealth-Focused Rural Health Research Center during the period of performance. HRSA will provide additional guidance on the technical assistance components of the project throughout the period of performance.

For purposes of working with HRSA’s Telehealth-Focused Rural Health Research Center, all award recipients will need to secure an Institutional Review Board (IRB) Human Subject Review approval during the first Budget Period (9/1/2024-8/31/2025).

This may involve the award recipient establishing data transfer and use agreements with participating network members.

Award recipients will be required to submit a signed and dated Data Transfer and Use Agreement (DTUA) document establishing the terms and conditions under which the network members and applicant can acquire and use data from each other as it relates to the compliance with aggregate data reporting requirements associated with this cooperative agreement. The DTUA should include an attestation that the data that will be shared are appropriate and valid and de-identified. HRSA/OAT will provide more information about DTUAs after September 1, 2024.

Award recipients will be required to utilize HRSA’s Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program (EB-TNP) measures (also commonly referred to as Performance Improvement Measurement System (PIMS) measures to help monitor your project progress. HRSA will provide additional guidance on the technical assistance components of the project throughout the period of performance.

This will include providing a data-driven number of unduplicated patients that receive services and for whom data (including clinical and cost data) will be collected for

13 See def initions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide def inition at 2 CFR 180.995).

14 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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research/evaluation purposes for each year of the period of performance. This data will be used for in-person comparison analysis. Data are to be collected on all patients where telehealth services are used as part of the award and on a 1-to-1 comparison sample of patients who receive comparable services in-person. The comparison sample should only consist of patients who are receiving comparable services in-person and are of a similar demographic.

The BHI/EB-TNP program will document and monitor progress of the aforementioned goals through the collection of aggregate data from each BHI/EB-TNP award recipient and their network members. All network members will be required to collect and share aggregate data.

As such, award recipients will be required to analyze the integration of behavioral health services into their primary care settings under common metrics and protocols that will allow for a multi-site analysis of the effectiveness of those services. Such information will be provided in the first year of the project period. Award recipients will also participate in a broad-scale analysis and evaluation of the program coordinated by the Office for the Advancement of Telehealth (OAT) as well as individual award recipient analysis and evaluation.

Clinician Reimbursement: Award recipients must bill all services covered by a third-party reimbursement plan and should demonstrate plans to make every effort to obtain payments throughout all five (5) years of the period of performance. All the general claims data will be a critical part of the BHI/EB-TNP program evaluation. Recipients providing BHI/EB-TNP services that could be reimbursed by Medicaid, Children’s Health Insurance Programs (CHIP), Medicare or private insurance should highlight their ability to catalyze a sustainable network through their state’s reimbursement environment. More information about state-specific telehealth reimbursement can be found here: https://www.cchpca.org/compare/

Note: At the same time, award recipients may not deny services to any individuals because of an inability to pay. If awarded, the recipient may allocate funding from the award to pay practitioners for telehealth services only after documenting that the award recipient has attempted to seek third-party reimbursement and/or why it is not possible to receive third party reimbursement. If at any time post-award the award recipient seeks to use award dollars to reimburse practitioners for telehealth services, they will be required to receive approval from the project officer first. Approved utilization of funds will be limited to a percentage of the amount awarded within the budget period the request is made.

https://www.cchpca.org/compare/

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BHI/EB-TNP award recipients will be required to submit Memorandum of Agreement(s) that describe working relationships between the awardee and each member of the telehealth network. Each Memorandum of Agreement (MOA) shall be executed by the listed contact in the application or other appropriate official from the Originating Site with authority to commit the Originating Site to the project. HRSA will provide detailed instructions about this requirement after September 1, 2024. HRSA award recipients for this program that fail to bring on board network members, as indicated in their application, may receive a reduction in award amount, in subsequent budget periods of the period of performance.

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.

a. Project title;

b. Applicant organization name;

c. Applicant organization address (street, city, county, state, ZIP code);

d. Applicant organization website, if applicable;

e. Requested award amount;

f. Applicant organization facility type (See Section III.1.B for examples);

g. Project Director name and title;

h. Project Director contact information (phone and e-mail);

i. Funding Preferences – A funding preference will be granted to any qualified applicant that demonstrates it meets at least one of the criteria for the preference (see Section V.2). Please state here whether or not you meet at least one of the criteria for the funding preference listed in Section V.2, and if you meet at least one of the criteria, provide a brief explanation as to why.

j. Service Area – Briefly identify the geographic service area that the telehealth network serves or will serve, including its size and population. Note how many full and partial Health Professional Shortage Areas (HPSAs) and full and partial Medically Underserved Areas (MUAs) the service area contains. Also, note any mental health and/or dental HPSAs. Note any other critical characteristics of the service area and its population.

k. Needs, Objectives, and Projected Outcomes – Briefly describe the identified needs and expected demand for telebehavioral health services, project objectives, and expected outcomes.

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l. Indicate the number of rural and underserved Originating Sites to be supported through this BHI/EB-TNP opportunity.

m. Actual Patients/Persons Served – Specify the actual number of unduplicated patients/ persons served throughout Calendar Year (CY) 2023 (January 1 – December 31, 2023) at the partner sites proposed for the BHI/EB-TNP project. Estimate (by site and year) the number of unduplicated patients/persons to be served at each site during the first year of the program and in subsequent years 2, 3, 4, and 5 (ending 8/31/29).

n. Self-Assessment – Briefly describe how the applicant plans to measure their progress achieving the goals stated in their application.

o. Outcomes - Telehealth Services – Describe the project’s anticipated added value to healthcare using telehealth resulting from the evaluation of the proposed services.

p. Additional Activities – Describe any additional services and activities for which the network is being utilized or will be utilized and include an estimated amount of time (administrative meetings, community meetings, etc.). Note:

Applicants that strictly propose such additional services and exclude direct delivery of telebehavioral health services to patients in rural and underserved communities, via telemedicine, will not be considered eligible for award funding support (Section III.3).

q. Sustainability – Briefly describe activities to sustain the telehealth network once federal funding ends.

r. Indicate if you are a recipient of a current EB-TNP award, and whether you serve/d as the applicant organization or an Originating Site;

s. Indicate whether you have applied for an EB-TNP award or were an Originating Site included in an EB-TNP application;

t. How the applicant learned about this funding opportunity (e.g., OAT Announcements, HRSA eNews, Grants.gov, www.Telehealth.HHS.gov, Telehealth Resource Centers, FORHP Announcements, State Office of Rural Health, etc.).

u. State Consultation: Indicate whether a consultation with the SORH or other relevant entity occurred.

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.

http://www.telehealth.hhs.gov/

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Narrative Section Review Criteria

Introduction Criterion 1: Need

Organizational Information Criterion 5: Resources/Capabilities

Need Criterion 1: Need

Approach Criterion 2: Response

Criterion 4: Impact

Work Plan Criterion 2: Response

Criterion 4: Impact

Resolution of Challenges Criterion 4: Impact

Evaluation and Technical Support Capacity

Criterion 3: Evaluative Measures

Criterion 5: Resources/Capabilities

Budget Narrative Criterion 6: Support Requested

ii. Project Narrative

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

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

This ensures reviewers can understand your proposed project.

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 (Need)

Succinctly (1-2 pages) describe the purpose, goals, activities and expected outcomes of the proposed project. The introduction should provide a brief overview of the telehealth network members, the target population(s) and collaborative plans for addressing the identified health care need in rural and undeserved communities in your proposed service area, including a list of the types of telebehavioral health services that will be offered.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 (Resources/Capabilities)

This section provides insight into the organizational structure of the applicant’s proposed telehealth network and its ability to implement the activities outlined in the work plan. As a reminder, the required composition of the telehealth network is outlined in Section III.1.B.

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Applicants should include the following staffing and network information using the following subheadings: (1) Telebehavioral Health Network Site Identification,

(2) Organizational Chart, (3) Resources and Capabilities, (4) Network Strength and Capacity:

(1) Telebehavioral Health Network Site Identification:

For each Telehealth Network Site, the applicant must include the following information (list the Applicant Organization Site first) in a table format (include as Attachment 2):

a. Name of Site – List the name of the Telehealth site;

b. Street Address – Include City, State and Zip Code;

c. Name of County;

d. Rural Site: Specify (yes/no) whether this site is located in a Federal

Office of Rural Health Policy (FORHP) defined rural area, as defined by the HRSA supported Rural Health Information Hub

– Am I Rural? Tool;

e. Designated Point of Contact person, direct phone number, and primary email;

f. Site’s Uniform Resource Locator (URL).

g. Population of County where site is located;

h. Is this a Rural Originating Site (O) or Distant Site (D)? O/D

i. Site Employee Identification Number (EIN). Tribal entities may be exempt from this requirement;

j. National Provider Identifier (NPI) and Primary Taxonomy if the site bills for service. See https://npiregistry.cms.hhs.gov/. If the site name or address do not match the NPI registration, please explain;

k. Health Care Provider (HCP) number (if the site receives Universal Service funding). See http://www.usac.org/rhc;

l. Indicate whether this is a currently active or new distant or originating site (Note: if a new site, indicate the year it will be added to the network);

m. Indicate whether the site is located in the following areas:

i. An urban or rural area;

ii. A Health Professional Shortage Area (HPSA);

iii. A Partial Health Professional Shortage Area (p-HPSA);

iv. A Medically Underserved Area (MUA);

v. A Partially Medically Underserved Area (p-MUA);

vi. A Medically Underserved Population (MUP).

n. Description of the site’s facility (see Section III.1.B)

o. Indicate whether they are a National Health Service Corps (NHSC)

Site or NHSC–eligible Site (see https://nhsc.hrsa.gov/sites/eligibility- requirements.html for more details);

https://www.ruralhealthinfo.org/am-i-rural https://www.ruralhealthinfo.org/am-i-rural https://npiregistry.cms.hhs.gov/ http://www.usac.org/rhc

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p. Indicate if any of the proposed Network Member Sites have applied for an EB-TNP award in previous years, and whether they applied as the Applicant Organization or were included in the application as a Network Member Site. Mark N/A if not applicable: a) Telehealth Network Grant Program; and/or b) Evidence-Based Telehealth Network Grant Program.

Successive Network Member Sites: Successive pages of information should be used to identify each individual Network Member Site in the network, by including the information listed above for each site. At the top of each successive Network Member Site, label each Network Member Site appropriately (Site #2 of total # of Sites, Site #3 of total # of Sites, and so on).

(2) Organizational Chart (include as Attachment 7):

Provide a one-page figure that depicts the organizational structure of the project, including contractors and other significant collaborators. The organizational chart should illustrate where project staff are located and reporting lines for each component of the project. The relationship between all telehealth network members on the project (if any) and the applicant should be shown. The application should designate a project director, employed by the applicant organization, who has day-to-day responsibility for the technical, administrative, and financial aspects of the project and a principal investigator, who has overall responsibility for the project and who may be the same as the project director.

Project Director: The Project Director is typically the point person on the award, and makes staffing, financial, or other adjustments to align project activities with the project outcomes. You should detail how the Project Director will facilitate collaborative input across network members to fulfill the proposed project activities in the work plan and HRSA-required reporting requirements. If the Project Director serves as a Project Director for other federal awards, please list the federal awards as well as the percent FTE for that respective federal award. Each project staff member cannot bill more than 1.0 FTE across federal awards. If there will not be a permanent Project Director at the time of the award, recipients should make every effort to hire a Project Director in a timely manner and applicants should discuss the process and timeline for hiring. In this respect, please address the following:

A. Project Director (i.e., the number of known candidates, the projected start date or the position, etc.).

B. Staffing needs should have a direct link to the activities proposed in the project narrative and budget portion of the application. HRSA recommends you:

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1. Devote at least 0.25 FTE to the project director position;

2. Have at least one permanent staff at the time an award is made; and

3. Have a minimum total equal to 2.0 FTE allocated for implementation of project activities, met across two or more staffing positions, including the project director position.

Community Health Worker/Patient Coordinator: You should detail how the Community Health Worker will facilitate coordination with the distant site and the patients to implement the proposed project activities in the work plan and HRSA-required reporting requirements. In addition, HRSA recommends you have at least .50 FTE devoted to the Community Health Worker/Patient Coordinator position. These individuals act as a liaison or advocate and assist in implementation of programs, and help serve to:

A. Create connections between vulnerable populations and healthcare providers

B. Help patients navigate…