oppHRSA-18-014-cfda93.236-cidHRSA-18-014-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Grants to States to Support Oral Health Workforce Activities

Funding Opportunity Number: HRSA-18-014

Funding Opportunity Types: Initial: New and Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number: 93.236

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: March 12, 2018

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

Deadline extensions are not granted for lack of registration.

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

Issuance Date: January 11, 2018

Thomas Vallin, MPH Public Health Analyst, Oral Health Branch Telephone: (301) 443-1307 Fax: (301) 443-0162 Email: TVallin@hrsa.gov

Authority: Section 340G of the Public Health Service Act (42 USC §256g)

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Health Workforce (BHW), Division of Medicine and Dentistry is accepting applications for fiscal year (FY) 2018 for the Grants to States to Support Oral Health Workforce Activities program. The purpose of this program is to support states in developing and implementing innovative programs to address the oral health workforce needs of designated Dental Health Professional Shortage Areas (Dental HPSAs). The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner. Applicants should note that this program may be cancelled prior to award recommendations.

Applicants must be Governor-appointed, state governmental entities that address one or more of the thirteen activities listed in this Notice of Funding Opportunity (NOFO).

Only one application per state will be accepted. The state must provide a non-federal contribution to support the grant activities in an amount equal to not less than 40 percent of federal funds provided under the grant.

Funding Opportunity Title: Grants to States to Support Oral Health Workforce Activities

Funding Opportunity Number: HRSA-18-014 Due Date for Applications: March 12, 2018 Anticipated Total Annual Available FY2018 Funding: $9,200,000

Estimated Number and Type of Awards: Up to 23 grants Estimated Award Amount: Up to $400,000 per year Cost Sharing/Match Required: Yes

Project Period/Period of Performance: September 1, 2018 through August 31, 2022 (4 years)

Eligible Applicants:

Eligible applicants include only Governor-appointed, state government entities (such as the state office/division housing the state dental director, or a state-run university or dental school).

See Section III-1 of this NOFO, formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise. A short video for applicants explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

Technical Assistance

The following technical assistance webinar and conference call have been scheduled:

Webinar

Day and Date: Wednesday, January 24, 2018 Time: 2:00 p.m. ET Call-In Number: 1-800-857-5126 Participant Code: 5019189 Web link: https://hrsa.connectsolutions.com/state-oral-health_nofo18014/ Playback Number: 1-866-357-4204 Passcode: 5136

Conference Call

Day and Date: Tuesday, February 27, 2018 Time: 2:00 p.m. ET Conference Number: 1-800-857-5126 Participant Passcode: 5019189 Playback Number: 1-800-944-3584 Passcode: 5136 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/state-oral-health_nofo18014/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number and System for Award Management

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 AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Grants to States to Support Oral Health Workforce Activities program.

Program Purpose The purpose of this program is to help states develop and implement innovative programs to address the dental workforce needs of designated dental health professional shortage areas (Dental HPSAs) in a manner appropriate to each state’s individual needs.

The aim is to encourage and support state innovation that will increase oral health services for populations living in Dental HPSAs and to sustain those programs that increase the accessibility and quality of oral health services within Dental HPSAs.

Program Requirements Your application must propose one or more innovative programs to meet the oral health workforce needs of Dental HPSAs in your state. For the purposes of this funding opportunity, an “innovative program” is a new or significantly changed program or service delivery system for your state that uses new ideas, methods and/or approaches to address the oral health workforce needs of Dental HPSAs in your state.

Maintenance, expansion, or minor changes to an established program or service, is not considered an innovative program. Programs that simply increase funded positions or existing service capabilities are not considered innovative programs.

Allowable activities include:

1) Efforts to improve/increase dental recruitment and retention;

2) Provide grants and low-interest or no-interest loans to help dentists who participate in the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et. seq.) to establish or expand practices in designated dental health professional shortage areas by equipping dental offices or sharing in the overhead costs of such practices;

3) Establish or expand dental residency programs in coordination with accredited dental training institutions in states without dental schools;

4) Develop programs, in consultation with state and local dental societies, to expand or establish oral health services and facilities in Dental HPSAs, including services and facilities for children with special needs. Examples include:

i. The expansion or establishment of a community-based dental facility, free-standing dental clinic, consolidated health center dental facility, school-linked dental facility, or United States dental school-based facility;

ii. The establishment of a mobile or portable dental clinic; and

iii. The establishment or expansion of private dental services to enhance capacity through additional equipment or additional hours of operation;

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5) Placement and support of dental students, dental residents, and advanced dentistry trainees;

6) Continuing dental education, including distance-based education;

7) Practice support through teledentistry in accordance with state laws;

8) Community-based prevention services;

9) Coordination with local educational agencies within the state to foster programs that promote children going into oral health or science professions;

10) The establishment of faculty recruitment programs at accredited dental training institutions whose mission includes community outreach and service and that have a demonstrated record of serving underserved states; and

11) The development of a state dental officer position or the augmentation of a state dental office to coordinate oral health and access issues in the state.

In accordance with Sec. 340G(b)(13) of the Public Health Service Act, and in support of priorities related to opioid abuse and childhood obesity, the following activities are also allowed under this funding opportunity:

12) Dental workforce programs designed to address risk factors common to childhood obesity and dental caries; and

13) Dental workforce programs designed to address opioid abuse by advancing better practices for pain management and/or improving access to treatment and recovery services. Such programs may include the clinical training of oral health providers in the identification and treatment of individuals with substance use disorders.

Proposals that involve loan repayment and water fluoridation systems activities are discouraged. If included, the proposal must demonstrate that they do not duplicate other federal programs. Proposals that include dental sealant programs, must demonstrate significant innovative changes.

As the ability for states to be able to track their oral health workforce is essential to identifying and addressing workforce shortages, applicants from states who cannot adequately track and assess the oral health workforce capacity within their state must include the development/enhancement of this capacity in their proposal under Activity 11.

2. Background

This program, authorized by Title III of the Public Health Service Act Section 340G (42 USC §256g), awards grants to help states develop and implement innovative programs to address the dental workforce needs of designated Dental HPSAs in a manner appropriate to the states’ individual needs.

Section 340F of the PHS Act defines “a designated Dental Health Professional Shortage Area” as “an area, population group, or facility that is designated by the Secretary as a dental health professional shortage area under section 332 or designated by the applicable state as having a dental health professional shortage.” As of November 29, 2017, there were 5,777 federally designated Dental HPSAs impacting over 61 million individuals and it would take over 10,540 dentists, properly distributed, to

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remove these designations.1 For more information on Dental HPSAs, please visit the HRSA Data Warehouse at https://datawarehouse.hrsa.gov/Topics/ShortageAreas.aspx.

The program authorization provides for a number of specific activities that allow for a broad range of programs including support for dental pipeline and training programs, recruitment and retention programs for dental providers, the establishment or expansion of service delivery infrastructure, and population-based services and public health infrastructure. Funded state grants have included programs to expose dental and dental hygiene students to underserved rural clinical sites, target specific underserved populations such as those with substance use disorders and their families, leverage dental hygienists’ expanded scopes of practice in new care models, test new models of care using new types of oral health professionals, explore delivering care via teledentistry or mobile care models, test new payment models, and assist dentists in establishing or taking over rural practices. While the approaches states take may be diverse, one thing that is common in their approaches is the requirement to address their particular Dental HPSA workforce needs through innovation.

In addition to the specified activities, the program authorization also allows the Secretary to identify additional appropriate activities that states may pursue under this program. This funding opportunity includes two additional activities that align with the following clinical priorities:

Addressing opioid use disorder through safe and effective pain management and identification and treatment of substance abuse. Opioid overdose deaths in the United States quadrupled between 1999 and 2015 and rates of death involving heroin, synthetic opioids, or a combination have increased more rapidly in recent years.2 In 2015, opioid overdose deaths accounted for 63% of all drug overdose deaths in the United States.3 Overdose from prescriptions opioids has been a driving factor in the increase of opioid overdose deaths, with sales of opioids to pharmacies, hospitals, and doctors’ offices rising dramatically with no overall change the amount of pain Americans report.4 As prescribers of opioids in the United States, dentists can help minimize the potential for their misuse and increase access to dental treatment through prevention, early intervention, and health system integration. More detail can be found at https://www.hhs.gov/opioids/about-the-epidemic/index.html.

Addressing common risk factors for childhood obesity and dental caries. HRSA’s 2016 National Survey of Children’s Health found nearly one-third of children ages 10-17

1 BHW, HRSA, U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics as of November 29, 2017, accessed from the Fourth Quarter of Fiscal Year 2017 Designated HPSA Quarterly Summary at https://datawarehouse.hrsa.gov/tools/hdwreports/Reports.aspx on November 29, 2017.

2 O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006– 2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903. DOI:

http://dx.doi.org/10.15585/mmwr.mm6634a2.

3 ibid 4 Centers for Disease Control and Prevention, Opioid Overdose: Understanding the Epidemic, August 30, 2017. Accessed on September 27, 2017 from https://www.cdc.gov/drugoverdose/epidemic/index.html.

https://www.hhs.gov/opioids/about-the-epidemic/index.html https://datawarehouse.hrsa.gov/tools/hdwreports/Reports.aspx https://www.cdc.gov/drugoverdose/epidemic/index.html

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years are overweight or obese5. Prevalence of obesity among children ages 2-19 has risen from 5.2 percent in the early 1970s to 17.2 percent in 2013-2014.6 Dental caries also remain a concern. Untreated dental caries among children ages 5-19 stands at

18.6 percent with higher rates reported for Hispanics or Latinos (21.7 percent), non- Hispanic or Latino Black or African Americans (23.4 percent), and those below 100 percent of the federal poverty level (24.7 percent).7 Risk factors common to childhood obesity and dental caries include behavioral, psychosocial, medical, biological, cultural, sociodemographic, and community environmental and economic factors.8

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce can be located at the Health Workforce Glossary. In addition, the following definitions apply to the Grants to States to Support Oral Health Workforce Activities Program for Fiscal Year 2018.

• Dental Health Professional Shortage Area (Dental HPSA) – see Health Professional Shortage Area (HPSA)

• Disadvantaged Background – refers to a citizen, national, or a lawful permanent resident of the United States, the Commonwealths of Puerto Rico or the Marianas Islands, the U.S. Virgin Islands, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Republic of Palau, the Republic of the Marshall Islands, or the Federated State of Micronesia who is:

o Environmentally Disadvantaged – an individual’s environment has inhibited him/her from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school;

AND/OR

o Economically Disadvantaged – an individual from a family (a group of two or more individuals) with an annual income below a level based on low-income thresholds, according to family size established by the U.S.

Census Bureau, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary of Health and Human Services, for use in all health professions programs. The Secretary updates these

5 Child and Adolescent Health Measurement Initiative. Data Resource Center for Child and Adolescent Health. 2016 National Survey of Children’s Health (NSCH) data query. Retrieved [12/26/2017] from www.childhealthdata.org. CAHMI: www.cahmi.org.

6 Fryar, CD, Margaret, DC, and Ogden, CL. Prevalence of overweight and obesity among children and adolescents ages 2-19 years: United States, 1963-1965 through 2013 -2014. National Center for Health Statistics, Health E-Stats, July 2016.

7 National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017.

8 Chi, DL, Luu, M and Shu, F. A scoping review of epidemiologic risk factors for pediatric obesity:

implications for future childhood obesity and dental caries prevention research. J Public Health Dent.

2017 Jun;77 Suppl 1:S8-S31. doi: 10.1111/jphd.12221. Epub 2017 Jun 10.

https://bhw.hrsa.gov/grants/resourcecenter/glossary

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income levels in the Federal Register annually (see the Federal Register 82(121) 28862-28863 for current amounts);

AND/OR

o Educationally Disadvantaged – an individual who comes from a social, cultural, or educational environment that has demonstrably and directly inhibited the individual from obtaining the knowledge, skills, and abilities necessary to develop and participate in a health professions education or training program.

• Health Professional Shortage Area (HPSA) – a federal designation used to identify areas, populations, and facilities which have a shortage of either primary care, dental, and/or mental health providers as measured by the ratio of available discipline-specific providers to: the population of the area; a specific population group; or the number of those served by the facility. All federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), and that meet the requirements of Section 334 of the Public Health Service Act related to charging for services, shall be automatically designated as having such a shortage. More information on the HPSA criteria can be found at http://bhw.hrsa.gov/shortage/hpsas/designationcriteria/designationcriteria.html.

• Innovative Program – a new or significantly changed program or service delivery system that uses new ideas, methods and/or approaches, designed to improve how the dental workforce needs of designated Dental HPSAs are addressed. The program must be new to your state to be considered innovative.

Maintenance, expansion, or minor changes to an established program or service is not considered an innovative program. Programs that simply increase funded positions or service capabilities through efforts very similar to those already in use are not considered innovative programs.

• Integrated Care – a graduated spectrum of health services wherein a facility delivers primary care services and coordinates with behavioral health care, oral health care, and/or public health strategies and interventions.

• Interprofessional education (IPE) – when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes9. (WHO, 2010) The goals of interprofessional collaboration and education are to encourage increased knowledge of the roles and responsibilities of other disciplines, and to improve communication and collaboration among disciplines in future work settings.

• Medically Underserved Community (MUC) – a geographic location or population of individuals eligible for designation by the federal government as a HPSA, Medically Underserved Area, Medically Underserved Population, or

9 World Health Organization. 2010 Framework for Action on Interprofessional Education and Collaborative Practice. Geneva. World Health Organization.

https://www.gpo.gov/fdsys/pkg/FR-2017-06-26/pdf/2017-13312.pdf https://www.gpo.gov/fdsys/pkg/FR-2017-06-26/pdf/2017-13312.pdf http://bhw.hrsa.gov/shortage/hpsas/designationcriteria/designationcriteria.html

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Governor's Certified Shortage Area for Rural Health Clinic purposes. As an umbrella term, MUC also includes populations such as homeless individuals, migrant or seasonal workers, and residents of public housing.

• Rural – a geographical area that includes all non-metro counties. Note: to determine whether a geographical area is considered rural, you can use the Rural-Urban Commuting Area (RUCA) codes. Learn more about defining a rural population at https://www.hrsa.gov/rural-health/about-us/definition/index.html.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New and Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

Approximately $9,2000,000 is expected to be available annually to fund approximately 23 recipients. The FY 2018 President’s Budget does not request funding for this program. You may apply for a ceiling amount of up to $400,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The actual amount available will not be determined until enactment of the final FY 2018 federal appropriation. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds can be awarded in a timely manner.

The project period is September 1, 2018 through August 31, 2022 (4 years). Funding beyond the first year is dependent on the availability of appropriated funds for the Grants to States to Support Oral Health Workforce Activities program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include only Governor-appointed, state government entities, such as the office of the state’s dental director or a state-run university or dental school. In addition to the 50 States, eligible applicants include the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the U.S. Virgin Islands, American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Private institutions are not eligible to apply for these https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx https://www.hrsa.gov/rural-health/about-us/definition/index.html http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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grant dollars. States are encouraged to work with tribal entities to facilitate greater consultation and coordination between state and tribal governments.

All applications submitted by any state-governmental entity other than the office/division housing the state dental director (such as a state-run university or dental school) MUST contain a letter of support from either the Governor or the state’s dental director that specifically endorses the applicant as the state’s designated representative to apply for these federal dollars on the state’s behalf. Such applicants should coordinate with the office/division housing the state dental director as only one application per state will be accepted. The letter should detail how the state government will be actively involved in the project, to include defining the state’s investment of resources to the project and any planned coordination activities at the state level, and must be included in Attachment 7 of the application. Applications from state government entities, other than the office/division housing the state dental director, that do not contain this letter WILL NOT be considered for funding.

An application submitted by the state governmental office/division housing the state dental director does not need to include a letter of support from the Governor. For states without an official oral health program or without a state-level oral health leadership position, the eligible entity to apply on the state’s behalf would include the individual or entity within the state government that holds the primary responsibility for the state’s dental workforce.

2. Cost Sharing/Matching

Cost sharing/matching is required for this program. Section 340G(d) of the Public Health Service Act requires a 40 percent match in non-federal contributions for this grant. States must match at least 40 percent of federal funds provided under this grant either in cash or in-kind. In-kind contributions may include plant, equipment, and services and may be provided from state, local, or private sources. The budget justification narrative located in Section IV MUST include a line-item breakdown and narrative description of all matching funds proposed for this project. Matching funds must be non-federal contributions related directly to carrying-out project activities.

Applications that fail to address cost sharing/matching requirements will be deemed ineligible and not considered for funding under this announcement.

3. Other

Ceiling Amount Applications that exceed the ceiling amount of $400,000 per year, inclusive of both direct and indirect costs, will be considered non-responsive and will not be considered for funding under this notice.

Deadline Any application that fails to satisfy the deadline requirements referenced in Section IV.4 will be considered non-responsive and will not be considered for funding under this notice.

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Multiple Applications NOTE: Multiple applications from a state are not allowable.

If, for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application. In the event applications are received from more than one entity within a state, the application from the office/division housing the state dental director will supersede applications from any other state-governmental entity.

Other Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

Financial Support A student/trainee receiving support from award funds must be a citizen of the United States, a non-citizen national, or a foreign national having in his/her possession a visa permitting permanent residence in the United States.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov. You must use the SF- 424 Research and Related (R&R) application package associated with this NOFO following the directions provided at https://www.grants.gov/applicants/apply-for-grants.html.

Effective December 31, 2017 – You must use the Grants.gov Workspace to complete the workspace forms and submit your application workspace package. After this date, you will no longer be able to use PDF Application Packages.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing the NOFO (also known as “instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note, you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 https://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://www.grants.gov/search-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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R&R Application Guide in addition to the program specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise.

Applications must be submitted in the English language and must be in terms of U.S.

dollars (45 CFR § 75.111(a)).

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 65 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the application package do NOT count in the page limitation. Biographical Sketches do count in the page limitation.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) will not be counted in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

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

3) Where the prospective recipient is unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 8: Other Relevant Documents.

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

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole, including the innovative program(s) being proposed and tested;

2. Specific, measurable objectives that the project will accomplish;

3. How the proposed project for which funding is requested will be accomplished (i.e., the "who, what, when, where, why and how" of a project);

and

4. A list of the specific state activities being address by the proposed program.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

Briefly state the purpose of your proposed project and how it relates to the purpose of this funding opportunity. Outline the oral health workforce needs of your state’s Dental HPSAs, including those you propose to address through your project activities. Include the capacity of the existing state oral health care workforce and any gaps that exist. Include any relevant oral health workforce trends that have been identified.

Describe the specific Dental HPSAs you plan to target through your proposed innovative program(s), including the population, the oral health workforce, oral health care infrastructure, gaps in the oral workforce, and unmet oral health needs.

Include factors that contribute to the gaps and unmet needs such as location of services, language, geography, transportation barriers, or care coordination.

Describe specific populations or communities that your innovative program(s) will target within the Dental HPSAs including accessibility of oral health services, oral health status, and social determinants of health and any health disparities.

This section should help reviewers understand the needs of the Dental HPSAs and underserved populations in your state and how the project will improve oral health care for these populations. Current data should be used and cited whenever possible to support the information provided.

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RESPONSE TO PROGRAM PURPOSE -- This section includes 3 sub-sections — ;

(a) Methodology/Approach, b) Work Plan; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion

#2 (a).

Describe in detail your proposed project goals, objectives, activities, and intended outcomes. Objectives should be specific, measurable, achievable, and realistic within the four-year project period.

Clearly describe the innovative program(s) you plan to develop and implement to meet the oral health workforce needs of the Dental HPSAs identified in the Purpose and Need section of your narrative. For each program proposed, you must:

• Indicate which of the thirteen allowed activities the program falls under (see Section I.1 Purpose);

• Indicate if the program is new or, if not, what significant changes are proposed;

• Describe the new ideas, methods, and/or approaches that will be used.

Include a description of how your methods are new to the field and/or new to your state;

• Indicate what improvements in the dental workforce or the oral health services and delivery system you expect to see in the affected Dental HPSAs; and

• Describe how these improvements will increase access to high quality oral health services for the underserved populations.

• If you propose to scale-up a recently piloted innovative program you must, in addition to the requirements listed above, provide data from your pilot program that justifies its expansion.

• If you propose loan repayment and water fluoridation systems activities, you must describe other federal programs in the state that support these activities and demonstrate that the proposed activities do not duplicate the other federal programs.

Evaluation must be included as one of your objectives.

Describe your state’s oral health workforce data collection, analysis, and planning infrastructure. States who cannot adequately track and assess the oral health workforce capacity must include development/enhancement of this workforce capacity in their proposal under Activity 11. Applicants other than the office/ division housing the state dental director should coordinate with the relevant state entities to accomplish this objective.

Describe any state policies and regulations you are leveraging in your innovative project(s), including recent changes in your state’s practice acts or scopes of practice for any oral health providers.

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Cite existing evidence, where available, that supports the proposed methodologies.

If you propose to expand a recently tested innovative program, provide program data and evidence that supports its expansion.

(b) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (b).

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. Include a detailed description of how your state will develop, implement, complete, and evaluate the innovative program(s) proposed for this project. Include the major steps, activities, key milestones, a timeline for their completion, and the staff responsible for achieving the goals and objectives over the four-year project period.

List any project/performance sites and provide information regarding any consortium or contractual arrangements with any collaborating organizations.

Applicants may incorporate, by reference, the information from the Staffing Plan and Job Descriptions for Key Personnel (Attachment 1) or key personnel biographical sketches (uploaded in the SF-424 R&R Senior/Key Person Profile form) when discussing responsible staff.

Include a detailed work plan chart that contains:

• Goals and objectives of the project;

• Activities and steps that will occur to meet the corresponding goals and objectives;

• Responsibility of key staff and partners, and as appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities;

• Deliverables and/or products;

• If your plan includes awarding contracts, hiring staff, or making subawards, include your key internal processes in your work plan and timelines;

• Outcomes, including the number and distribution of the health workforce; and

• Timeline for completion.

Your work plan chart should contain sufficient detail to allow tracking progress on the implementation of your program on at least a quarterly basis. A sample work plan can be found here:

https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (c)

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan and the approaches that will be used to resolve such challenges. If your plan includes awarding contracts, hiring staff, or making subawards, describe any challenges, particularly timeline challenges, that https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf

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you are likely to encounter, including your internal processes, and the approaches you will use to minimize them. Describe any potential obstacles to implementing the evaluation objective and meeting HRSA’s reporting requirements (as described in Section IV.2.ii. IMPACT (a) Evaluation and Technical Support Capacity) and indicate how those obstacles will be addressed.

IMPACT -- This section includes 2 sub-sections— (a) Evaluation and Technical

Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion #3 (a)

You must include evaluation as an objective of your proposed program, include it in the work plan, and describe how you will evaluate the impact of your innovative program(s).

You must describe how program performance and outcomes will be evaluated against the goals and objectives of your proposal. For each proposed program indicate:

• What improvement(s) you expect over current or similar programs;

• How you plan to measure that improvement(s); and

• What level of achievement(s) will be considered successful?

In addition to measuring the impact of your program(s) on the oral health workforce, you should include how you will measure the impact of your innovative program(s) on: 1) access to care for the targeted Dental HPSAs, 2) quality of care received by patients in the targeted Dental HPSAs, and/or 3) the estimated cost effectiveness of the care delivered by your innovative program(s), and any other key evaluative measures you identify.

Describe how your staff, capabilities, experience, and plans demonstrate that you will have the expertise and the technical capacity to carry out the proposed evaluation activities. You may use funds to support an Evaluation Specialist to implement your evaluation activities. You may incorporate, by reference, the information from your Staffing Plan and Job Descriptions for Key Personnel (Attachment 1) or key personnel biographical sketches (uploaded in the SF-424 R&R Senior/Key Person Profile form) when discussing the organization’s technical support capacity.

You are encouraged to review oral health measures in Healthy People 2020 (https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health/objectives) and the Dental Quality Alliance website (http://www.ada.org/en/science-research/dental-quality-alliance/dqa-measure-activities).

https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health/objectives http://www.ada.org/en/science-research/dental-quality-alliance/dqa-measure-activities http://www.ada.org/en/science-research/dental-quality-alliance/dqa-measure-activities

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HRSA Required Performance and Progress Reporting HRSA requires awardees to report annually on workforce and oral health service outcomes in their annual Performance Reports. The current required data forms for this program may be viewed at https://bhw.hrsa.gov/sites/default/files/bhw/grants/performancemeasures/sohwp.pd f and most recent instructions at https://bhw.hrsa.gov/sites/default/files/bhw/grants/sohwp.pdf. Describe your strategy to collect, manage, analyze and track data (e.g., experience of assigned staff, data sources, frequency of data collection, analysis, etc.), including the systems and processes you will use, to report on HRSA’s performance measure.

Describe any potential obstacles for implementing your strategy to meet HRSA’s Annual Performance Report requirements and your plan to address them.

Awardees will also be required to report annually the progress on the program’s goals and objectives in the Annual Non-competing Continuation (NCC) Progress Report. Describe your strategy to collect, manage, and analyze data to monitor and report on the implementation of your work plan, progress toward meeting goals and objectives, and program accomplishments. Progress and results from your evaluation objective, will be expected.

Continuous Program Assessment and Improvement You must include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections. Additional information on RCQI is available at the following website:

http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion

#3 (b)

Awardees are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population.

You must propose a clear plan to sustain the successful key elements of your proposed innovative program(s) after the period of federal funding ends. Your plan should be realistic, feasible and include the following: 1) how your evaluation results will be used to support sustaining effective key elements of the program; 2) strategies to achieve sustainability; 3) challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges; and 4) identification of potential sources of support to include financial, in-kind, and/or absorption of activities by program partners. Do not assume that additional grant support beyond the four-year project period will be available to sustain your program.

https://bhw.hrsa.gov/sites/default/files/bhw/grants/performancemeasures/sohwp.pdf https://bhw.hrsa.gov/sites/default/files/bhw/grants/performancemeasures/sohwp.pdf https://bhw.hrsa.gov/sites/default/files/bhw/grants/sohwp.pdf http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

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ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Provide information on your current mission, structure and scope of current activities and describe how these contribute to your organization’s ability to leverage available resources, and meet the program requirements and expectations. If you are not part of the state health department, then include a description of the role of the state health department in your proposed project.

Describe how the unique needs of target populations in the Dental HPSAs served are routinely assessed. Identify and describe, in detail, the facilities and organizational resources of the project’s performance site(s). For all key personnel, describe current positions, skills and knowledge, and any previous experience that may justify their proposed role in the project.

Describe collaborative linkages and partnerships, such as state oral health coalitions, dental schools, other state divisions/departments (Primary Care Office, Rural Health, Medicaid Directors, etc.), local health departments, and school districts. Include a Project Organizational Chart (Attachment 3) that demonstrates effective collaboration among partners and proper oversight of progress and activities.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 1 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile form, which can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch.

Biographical sketches, not exceeding two pages per person, should include the following information:

• Senior/key personnel name

• Position Title

• Education/Training – beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-

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suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors.

Include present membership on any federal Government public advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

• Section D (optional) Other Support. List both selected ongoing and completed (during the last three years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Narrative Section Review Criteria

Purpose and Need (1) Purpose and Need

Response to Program Purpose:

(a) Methodology/Approach

(b) Work Plan

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Methodology/Approach

(b) Work Plan

(c) Resolution of Challenges

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources and Capabilities

(4) Organizational Information, Resources and Capabilities

Budget and Budget Narrative (see below)

(5) Support Requested

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iii. Budget

See Section 4.1.iv of HRSA’s SF-424 R&R Application Guide. Please note: the directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov.