oppHRSA-18-020-cfda93.932-cidHRSA-18-020-instructions.pdf

HRSA-18-020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Primary Health Care

Native Hawaiian Health Care Improvement Act

Funding Opportunity Number: HRSA-18-020

Funding Opportunity Type(s): Limited Competition Catalog of Federal Domestic Assistance (CFDA) Number: 93.932

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: April 20, 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: February 16, 2018

Dave Butterworth Public Health Analyst, Bureau of Primary Health Care

(301) 594-4300 BPHCNH@hrsa.gov NH Technical Assistance Web site:

https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

Authority: Native Hawaiian Health Care Improvement Act, as amended (42 U.S.C. 11701 - 11714)

ATTENTION: This NOFO is for previously identified organizations that have been appropriated money by Congress for specific projects. This notice is not open to the public.

https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Primary Health Care is accepting applications for fiscal year (FY) 2018 Native Hawaiian Health Care Improvement Act (NHHCIA). The purpose of this grant program is to improve the provision of comprehensive disease prevention, health promotion, and primary care services to Native Hawaiians. Applicants are limited to currently funded Native Hawaiian Health Care Systems (NHHCS) and Papa Ola Lokahi (POL), whose project periods expire on July 31, 2018.

Funding Opportunity Title: Native Hawaiian Health Care

Improvement Act Funding Opportunity Number: HRSA-18-020 Due Date for Applications: April 20, 2018 Anticipated Total Annual Available FY18 Funding:

$12,967,553

Estimated Number and Type of Award(s): Six grants Estimated Award Amount: Varies by organization (see Table 1) Cost Sharing/Match Required: Yes

All applicants, except POL, must accrue non-federal matching funds in an amount equal to $1 for every $5 of federal funds.

Project Period/Period of Performance: August 1, 2018 – July 31, 2021 (up to 3 years)

Eligible Applicants: To be eligible for funding, an applicant must be one of the organizations listed in Table 1.

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

Application Guide

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

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

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Technical Assistance

Application resources, as well as form samples and a frequently asked questions document, are available at the NHHCIA Technical Assistance Web site (https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/) Refer to “How to Apply for a Grant”, available at http://www.hrsa.gov/grants/apply, for general (i.e., not NHHCIA specific) videos and slides on a variety of application and submission components.

Summary of Changes (compared to FY 2015 Limited Competition)

• The term Notice of Funding Opportunity (NOFO) has replaced the term Funding Opportunity Announcement (FOA).

• You must use the Grants.gov Workspace to complete the Grants.gov forms and submit your application.

• “Collaboration” has been added as a new criterion in both the Project Narrative and Review Criteria sections of the NOFO.

• A Medicaid reimbursement arrangement is required if NHHCS provides services directly or through a contract with an organization [42 U.S.C. 11707(a)(c)].

• The Clinical Performance Measures were updated to reflect the most current list of relevant Clinical Performance Measures.

http://www.hrsa.gov/grants/apply http://www.grants.gov/web/grants/applicants/workspace-overview.html

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

APPENDIX B: PERFORMANCE MEASURES

APPENDIX C: INCOME ANALYSIS FORM INSTRUCTIONS

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I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

This notice solicits applications for the Native Hawaiian Health Care Improvement Act (NHHCIA) program. The NHHCIA, as amended (42 U.S.C. 11701 - 11714), states that “it is the policy of the United States in fulfillment of its special responsibilities and legal obligations to the indigenous people of Hawaii … to (1) raise the health status of Native Hawaiians to the highest possible health level; and (2) provide existing Native Hawaiian health care programs with all resources necessary to effectuate this policy” [see 42 U.S.C. 11702(a)]. The NHHCIA authorizes funding for the following activities:

• Service grant to Papa Ola Lokahi (POL) for the activities described in the NHHCIA, including the coordination of the health care programs and services provided to Native Hawaiians.

• Service grants to the five recognized community-based Native Hawaiian Health Care Systems (NHHCS) to provide a full range of services identified by the legislation and tailored to fit the needs of their respective island communities.

This is a limited competition program announcement. This NOFO provides instructions to be used by existing recipients under the NHHCIA in preparing applications for funding for fiscal years 2018 through 2020.

2. Background

This program is authorized under the NHHCIA, as amended (42 U.S.C. 11701 and 11714). The Native Hawaiian population experiences barriers to accessing health care services that significantly impact overall health status. Geographic isolation from health services is also a serious barrier for many Native Hawaiians.

As a result of these and other barriers, Native Hawaiians suffer disproportionately from many chronic diseases that underlie premature disability and high morbidity and mortality rates. When compared to other population groups, Native Hawaiians have significantly higher rates of diabetes mellitus, heart disease, obesity, stroke, asthma, hypertension, dental caries, and cancer.

Program Requirements

NATIVE HAWAIIAN HEALTH CARE SYSTEMS (NHHCS)

NHHCS receiving grants under the NHHCIA program are required to provide comprehensive disease prevention, health promotion, and primary health services to Native Hawaiians, either directly or through contract per 42 U.S.C. 11705. Specifically, NHHCS are required to provide the following mandatory services in accordance with the authorizing legislation [see 42 U.S.C. 11705(c)(1)(A-G)]:

(A) Outreach services to inform Native Hawaiians of the availability of health services;

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(B) Education in health promotion and disease prevention of the Native Hawaiian population by, wherever possible, Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators;

(C) Services of physicians, physicians’ assistants, nurse practitioners, or other health professionals;

(D) Immunizations;

(E) Prevention and control of diabetes, high blood pressure, and otitis media;

(F) Pregnancy and infant care; and

(G) Improvement of nutrition.

In addition to the mandatory services above, the following services are authorized under the statute and may be provided by NHHCS but are not mandated [see 42 U.S.C.

11705(c)(2)(A-C)]:

(A) Identification, treatment, control, and reduction of the incidence of preventable illnesses and conditions endemic to Native Hawaiians;

(B) Collection of data related to the prevention of diseases and illnesses among Native Hawaiians; and

(C) Services within the meaning of the terms "health promotion," "disease prevention," and "primary health services" as defined under the NHHCIA [see 42 U.S.C.

11711], as excerpted below.

42 U.S.C. 11711(1) Disease Prevention The term “disease prevention” includes:

a) Immunizations;

b) Control of high blood pressure;

c) Control of sexually transmittable diseases;

d) Prevention and control of diabetes;

e) Control of toxic agents;

f) Occupational safety and health;

g) Accident prevention;

h) Fluoridation of water;

i) Control of infectious agents; and

j) Provision of mental health care.

42 U.S.C. 11711(2) Health Promotion The term “'health promotion'” includes:

a) Pregnancy and infant care, including prevention of fetal alcohol syndrome;

b) Cessation of tobacco smoking;

c) Reduction in the misuse of alcohol and drugs;

d) Improvement of nutrition;

e) Improvement in physical fitness;

f) Family planning;

g) Control of stress; and

h) Educational programs with the mission of improving the health, capability, and well-being of Native Hawaiians.

42 U.S.C. 11711(8) Primary Health Services

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The term “primary health services” includes:

a) Services of physicians, physicians' assistants, nurse practitioners, and other health professionals;

b) Diagnostic laboratory and radiologic services;

c) Preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services);

d) Emergency medical services;

e) Transportation services as required for adequate patient care;

f) Preventive dental services; and

g) Pharmaceutical services, as may be appropriate.

Governance: Each NHHCS must be organized under the laws of the State of Hawaii;

provide or arrange for health care services through practitioners licensed by the State of Hawaii; and be a public or nonprofit private entity in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services (see 42 U.S.C. 11711(4)).

PAPA OLA LOKAHI (POL)

POL is required to perform the following activities in accordance with the administrative grant section of the authorizing legislation [see 42 U.S.C. 11706].

1. Coordinate, implement, and update a Native Hawaiian comprehensive health care master plan designed to promote comprehensive health promotion and disease prevention services and to maintain and improve the health status of Native Hawaiians [see 42 U.S.C. 11703(a), 11704(a)(1), and 11706(a)(1)].

2. Conduct training for Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators to educate the Native Hawaiian population regarding health promotion and disease prevention [see 42 U.S.C.

11704(a)(2) and 11706(a)(2)].

3. Identify and perform research into the diseases that are most prevalent among Native Hawaiians [see 42 U.S.C. 11704(a)(3) and 11706(a)(3)].

4. Develop an action plan outlining the contributions that each member organization of POL will make in carrying out the policy of the NHHCIA [see 42 U.S.C.

11704(a)(4) and 11706(a)(4)].

5. Serve as a clearinghouse for NHHCIA [see 42 U.S.C. 11704(c) and 11706(a)(5)]:

(A) Collection and maintenance of data associated with the health status of

Native Hawaiians;

(B) Identification and research into diseases affecting Native Hawaiians; and

(C) Availability of Native Hawaiian project funds, research projects, and publications.

6. Coordinate and assist with the health care programs and services provided to

Native Hawaiians [see 42 U.S.C. 11704(d) and 11706(a)(6)].

7. Administer special projects pursuant to 42 U.S.C. 11704(b) and 11706(a)(7).

Additionally, POL is responsible for [see 42 U.S.C. 11711(6)(F)]:

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1. Recognizing the full universe of NHHCS for the purpose of planning, conducting, or administering programs, or portions of programs, authorized by this chapter for the benefit of Native Hawaiians.

2. Certifying NHHCS that have the qualifications and the capacity to provide the services and meet the requirements of this program.

Governance: The Board of POL consists of Alu Like, E Ola Mau, Ho`ola Lahui Hawai`i, Hui Malama Ola Na `Oiwi, Hui No Ke Ola Pono, Ke Ola Mamo, Na Pu’uwai, the Office of Hawaiian Affairs of the State of Hawaii, the Office of Hawaiian Health of the Hawaii State Department of Health, the University of Hawaii, and other entities or organizations which the POL deems appropriate to achieve its stated purpose (unless the Secretary determines that the entity has not developed a mission statement and action plan pertaining to contributions the organization will make to the NHHCS [see 42 U.S.C.

11711(7)]).

Failure to meet NHHCIA funding requirements may jeopardize grant funding per Uniform Guidance 2 CFR part 200 as codified by the United States Department of Health and Human Services (HHS) at 45 CFR part 75. HRSA will assess award recipients for compliance prior to and during the project period. When non-compliance is identified (e.g., an NHHCS fails to accrue non-federal matching funds in an amount equal to $1 for every $5 of federal funds, an organization does not adhere to program requirements), HRSA will take action to resolve compliance issues, which may include the placement of conditions and or draw down restriction on the award. If an organization fails to successfully resolve compliance issues, HRSA may withdraw support through the cancellation of all, or part, of the grant award.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: Competing Continuation (for limited competition)

HRSA will provide funding in the form of a grant.

2. Summary of Funding

Approximately $13.0 million is expected to be available annually to fund six recipients.

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 awarded in a timely manner.

The project period is August 1, 2018 through July 31, 2021 (3 years). For the purpose of this application, you may apply for the ceiling amount listed in Table 1 (includes both direct and indirect, facilities and administrative costs) per year. However, the ceiling amount for each award recipient may vary for each future budget period within the project period and will be announced through the Non-Competing Continuation instructions http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl 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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document. Funding beyond the first year is dependent on the availability of appropriated funds for the NHHCIA program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

Table 1: Maximum Awards for FY 2018 Recipient Name Maximum Funding Amount

Ho’ola Lahui Hawaii $2,410,509 Hui Malama Ola Ha’Oiwi $2,377,840 Hui No Ke Ola Pono $2,674,268 Ke Ola Mamo $2,491,978 Na Pu’uwai $1,904,757 Papa Ola Lokahi (POL) $1,108,201 Total $12,967,553

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

III. Eligibility Information

1. Eligible Applicants

This Congressional Special Initiative is a limited competition program notice. To be eligible for funding, an applicant must be one of the organizations listed in Table 1.

2. Cost Sharing/Matching

Cost sharing/matching is required for this program. As described in the authorizing statute [42 U.S.C. 11705(e)], all applicants, except POL, must accrue non-federal matching funds in an amount equal to $1 for every $5 of federal funds (see Budget for details). This means that at least 16.7 percent of the total budget must be paid for with non-federal resources.

Non-federal contributions may be in cash or in-kind. In-kind contributions must be fairly evaluated and may include plant, equipment, or services. Amounts provided by the federal government or services assisted or subsidized to any significant extent by the federal government may not be included in determining the amount of such non-federal contributions. Federal sources may be used as matching funds if received as fees, payments, or reimbursements for the provision of a specific service, such as patient care reimbursements received under Medicare or Medicaid. Generated program income may be used as matching funds.

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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3. Other

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

NOTE: Multiple applications from an organization 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.

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 application package associated with this NOFO, following the directions provided at http://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 Grants.gov application 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 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 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. Applications must be submitted in the English language and must be in the terms of U.S. dollars (45 CFR § 75.111(a)).

If HRSA receives an incomplete or non-responsive application, additional information may be requested during application review, which could result in a delay in NoA issuance.

http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html

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See Section 8.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 100 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the application package do not 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 the statements in this certification, an explanation shall be included in Attachments 13-15: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 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 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), please include the following:

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 Application Guide. In addition to the information requested in the application guide, the project abstract must provide a brief history of the organization and how the proposed project will address the health care needs in the Native Hawaiian population.

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.

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

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Successful applications will contain the information below. Please use the following section headers for the narrative: Need, Project Update, Response, Collaboration, Evaluative Measures, Resources/Capabilities, and Support Requested.

• The requested information should appear in the appropriate section of the Project

Narrative or the designated forms and attachments.

• Reference attachments and forms as needed to clarify information about the applicant organization, proposed activities, and key personnel. Referenced items must be part of the submission.

NATIVE HAWAIIAN HEALTH CARE SYSTEMS (NHHCS): Narrative Instructions

NEED (Corresponds to Section V’s NHHCS Review Criterion #1)

1) Using reliable “island-specific” data for the population of individuals who will be served, describe the unique characteristics of the target population that affect access to health care, health care utilization, and health status, including:

a. Island-specific geographic areas where significant numbers of Native Hawaiians will be served.

b. Demographic, cultural, and ethnic factors.

c. Unemployment or educational factors.

d. Barriers to accessing health services (e.g., cultural or language issues, access issues related to managed care or reimbursement, geography, or transportation).

e. The health status and treatment needs of the target population (i.e., unique or special treatment needs).

2) Describe the health care environment of the service area and target population, including:

a. Existing health services currently available to the target population.

b. Service delivery considerations.

c. Significant changes that affect the availability of health care services.

PROJECT UPDATE (Corresponds to Section V’s NHHCS Review Criterion #2)

The project update should cover the time period of August 1, 2017 to February 28, 2018 and address the following:

1) Describe the services and program activities for the project period, as proposed in the

FY 2015 limited competition application and adjusted in the FY 2017 non-competing continuation progress report submission, including:

a. Progress, milestones, and accomplishments.

b. Challenges and barriers, and how they have been addressed.

c. Major changes or adjustments to the project, including changes in the service area and population served, services provided, and/or agreements with other

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organizations to provide services to the target community. Describe how those changes comply with NHHCIA legislation.

2) The status of any unresolved issues, including business/management issues, identified in the previous Notice of Award (NoA) and/or site visit.

3) The status of any audit conditions or exceptions as identified in the most recent audit report.

4) How the legislative match requirement was met.

RESPONSE (Corresponds to Section V’s NHHCS Review Criterion #3) The Response should address services to be provided and program activities that will occur over the 3-year project period of August 1, 2018 to July 31, 2021.

1) Describe the services and activities planned to address the needs of the target population and meet the requirements outlined in the authorizing legislation. Using the services listed in Appendix A, describe how all required and the additional services, will be provided by the organization as part of the proposed project.

2) Describe arrangements with other organizations to provide services, including contractual and financial agreements between the NHHCS and other health care entities in the community (e.g., health centers, Area Health Education Centers, hospitals, universities, community-based organizations).

3) Outline a plan to assure that all newly proposed activities will be initiated within 120 days of award.

4) Describe continuous quality improvement/quality assurance plans and activities relevant to the proposed project.

COLLABORATION (Corresponds to Section V’s NHHCS Review Criterion #4)

1) Describe and document in Attachment 11 (e.g., dated letters of support, signed memoranda of agreement) efforts to collaborate with other Native Hawaiian Health Care programs and/or other organizations providing health services to Native Hawaiians in the service area.

2) Describe collaboration with POL to carry out the mission of the NHHCIA. Include a copy of any formal agreement as part of Attachment 13: Other Relevant Documents.

EVALUATIVE MEASURES (Corresponds to Section V’s NHHCS Review Criterion #5)

1) Provide in Attachments 2, 3, 4, and 5 realistic and achievable goals for required and optional services and financial indicators as described in Appendix B (see Appendix B for instructions).

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2) Describe how progress towards meeting identified goals will be measured and evaluated.

3) Describe how evaluation results will be used to improve program performance over the course of the project period.

RESOURCES/CAPABILITIES (Corresponds to Section V’s NHHCS Review Criterion #6)

1) Describe the experience and expertise of the proposed personnel, as well as the organizational capacity to implement the project.

2) Describe the retention and recruitment of qualified staff, including the recruitment of Native Hawaiian scholars in concert with POL.

3) Describe the organization’s corporate compliance competences, including financial and operational oversight, and review and update of malpractice and other insurances.

4) Describe the organization’s data analysis and data reporting capability required to meet the Program Requirements in the NHHCIA.

5) Describe how the organization’s governing board, listed in Attachment 10, complies with the legislation (see Governance), and how it monitors and evaluates the organization’s operational and financial performance.

6) Describe the organization’s fiscal management and management information systems (MIS) capacity, including financial leadership at the staff and board levels, as indicated in Attachments 8, 9, and 10.

7) Describe the organization’s revenues and collection activities, including self-pay income, third-party reimbursement, and sliding-fee schedule collections, consistent with Attachment 6. Describe the organization’s fiscal status and plans for maintaining long-term financial viability, including establishment or maintenance of the required Medicaid reimbursement arrangement.1

SUPPORT REQUESTED (Corresponds to Section V’s NHHCS Review Criterion #7)

1) Provide a complete and detailed budget presentation through submission of the SF- 424A and Budget Narrative (see Section 4.2.iii. Budget and Section 4.2.iv. Budget Narrative for details) that aligns and is consistent with identified needs, proposed activities, and project goals.

2) Demonstrate that funds will not be duplicative or used to supplant or replace existing resources.

1 A Medicaid reimbursement is required if the entity provides services directly or if the entity will provide such health services through a contract with an organization 42 U.S.C. 11707(a)(c).

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3) Describe plans to:

a. Acquire the non-federal matching funds in an amount equal to $1 for every $5 of federal funds.

b. Adhere to the 10 percent administrative cap.

Please note: If you have assessed that you will be unable to comply with the matching requirement, take action to achieve full compliance before submitting your application.

PAPA OLA LOKAHI (POL): Narrative Instructions

NEED (Corresponds to Section V’s POL Review Criterion #1)

1) Describe the need for and barriers to training Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators who are carrying out health promotion and disease prevention education activities for the Native Hawaiian population.

2) Describe the need for and barriers to collecting data associated with the health status of Native Hawaiians, including aggregate data related to the services provided by the

NHHCS.

3) Describe the need for and barriers to identifying and researching the diseases that are most prevalent among Native Hawaiians.

4) Describe the need for and barriers to coordinate, implement, and update a Native

Hawaiian comprehensive health care master plan designed to promote comprehensive health promotion and disease prevention services and to maintain and improve the health status of Native Hawaiians.

PROJECT UPDATE (Corresponds to Section V’s POL Review Criterion #2)

The Project Update should cover the time period of August 1, 2017 to February 28, 2018 and address the following:

1) Describe the services and program activities for the project period, as proposed in the

FY 2015 limited competition application and adjusted in the FY 2017 non-competing continuation progress report submission, including:

a. Progress, milestones, and accomplishments.

b. Challenges and barriers, and how they have been addressed.

c. Major changes or adjustments to the project, including changes in the services provided, and/or agreements with other organizations to provide services. Describe how all changes comply with NHHCIA legislation.

2) The status of any unresolved issues identified in the previous NoA and/or site visit.

3) Provide progress on the FY 2017 Project Work Plan Update, including:

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a. Progress in implementing the activities and meeting specific performance goals described in the Work Plan (see the Program Requirements section for details).

b. Continuous performance improvement activities.

c. Plans for maintaining long-term viability (e.g., financial viability, future requirements for space, personnel, and capital).

d. Recruitment and retention of qualified staff.

e. Governance and board development.

f. Fiscal status and your management information systems (MIS) capabilities.

RESPONSE (Corresponds to Section V’s POL Review Criterion #3)

The Response should address services to be provided and program activities that will occur over the 3-year project period of August 1, 2018 to July 31, 2021.

1) Provide a 3-year Project Work Plan that addresses the health care environment and the requirements of the legislation (see Program Requirements) as Attachment 1 (a sample is available at https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/). Include the following sections in the plan table:

a. Goal – Goals should be time-framed, measureable, and designed to meet the Program Requirements.

b. Key Action Steps – Activities that will contribute to the achievement of a goal.

c. Timeline – When each action step will be accomplished.

d. Expected Outcome – The predicted result of the action step, which quantifies what the action step will accomplish.

e. Data Source and Evaluation Methodology – Where the data originated (e.g., name and date of survey) and the process for tracking and measuring change.

f. Person/Area Responsible – Who will be accountable for accomplishing the action step.

g. Collaborative Partners –The community or member organizations that will contribute to carrying out the Key Action Steps.

2) Describe how the activities detailed in the Project Work Plan are consistent with the identified needs.

3) Describe how the full universe of NHHCS – including both existing and new organizations – will be planned, recognized, and certified over the course of the project period such that multiple qualified NHHCS may be positioned to serve one or more of the identified island communities in FY 2021. Include a description of how the planning, recognition, and certification processes will be publicized to the island communities.

4) Outline a plan to assure that all newly proposed activities will be initiated within 120 days of award.

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COLLABORATION (Corresponds to Section V’s POL Review Criterion #4)

1) Describe and document in Attachment 11 (e.g., dated letters of support, signed memoranda of agreement) efforts to coordinate and assist with the health care programs and services provided to Native Hawaiians.

2) Describe collaboration with the five NHHCS to carry out the mission of the NHHCIA.

Include a copy of any formal agreements as part of Attachment 13: Other Relevant Documents.

EVALUATIVE MEASURES (Corresponds to Section V’s POL Review Criterion #5)

1) Describe how progress towards meeting identified goals and expected outcomes will be evaluated.

2) Describe how evaluation results will be used to improve program performance over the course of the project period.

RESOURCES/CAPABILITIES (Corresponds to Section V’s POL Review Criterion #6)

1) Describe the experience and expertise of the proposed personnel, including the organizational capacity to implement the project.

2) Describe how you will assist the NHHCS with the retention and recruitment of qualified staff, including the recruitment of Native Hawaiian scholars.

3) Describe how the organization’s governing board, listed in Attachment 10, complies with the legislation (see Governance), and how it monitors and evaluates the

4) Describe the organization’s fiscal management and management information systems (MIS) capacity, including financial leadership at the staff and board levels, as indicated in Attachments 8, 9, and 10.

5) Describe the organization’s fiscal status and plans for maintaining long-term financial viability.

6) Describe the organization’s data analysis and data reporting capability required to meet the Program Requirements in the NHHCIA.

SUPPORT REQUESTED (Corresponds to Section V’s POL Review Criterion #7)

1) Provide a complete and detailed budget presentation through the submission of the

SF-424A and Budget Narrative (see Section 4.2.iii. Budget and Section 4.2.iv. Budget Narrative for details) that aligns and is consistent with identified needs, proposed activities, and project goals.

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2) Demonstrate that funds will not be duplicative or used to supplant or replace existing resources.

To ensure that you fully address the Review Criteria, this table provides a crosswalk between relevant Narrative and Review Criteria sections.

Narrative Section Review Criteria Need (1) Need Project Update (2) Project Update Response (3) Response Collaboration (4) Collaboration Evaluative Measures (5) Evaluative Measures Resources/Capabilities (6) Resources/Capabilities Support Requested (7) Support Requested

iii. Budget

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

Please follow the instructions included in the Application Guide and the additional budget instructions provided below. A budget that follows the Application Guide will ensure that, if the application is selected for funding, you will have a well-organized plan and, by carefully following the approved plan, can avoid audit issues during the implementation phase.

While the NHHCIA project period is for 3 years, the funding will continue to be appropriated and awarded annually. As such, provide budget and budget justification information for the first year (as listed in Table 1) of the 3-year project period. Applications that exceed the ceiling amount will only be awarded the funding listed in Table 1.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

In addition, the NHHCIA program requires the following:

STANDARD FORM 424A:

Complete Sections A, B, C, E, and F of the SF-424A Budget Information – Non- Construction Programs. The budget must be prepared for the requested first 12-month period (August 1, 2018 – July 31, 2019) as listed in Table 1. All budget amounts must be rounded to the nearest whole dollar.

The following guidelines must be used in the completion of the SF-424A. A sample SF- 424A is available at https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/.

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SECTION A – BUDGET SUMMARY

Under New or Revised Budget, use the rows 1-4 to provide the proposed budget for the first 12-month budget period.

SECTION B – BUDGET CATEGORIES

Provide the object class category breakdown for the annual amount specified in Section A. Each line represents a distinct object class category that must be addressed in the Budget Narrative. The federal, match, and administrative expenses must be entered in columns 1, 2, and 3 (label the columns accordingly) and equal the total proposed budget identified in Section A. Applicants (with the exception of POL) are required to show the 10 percent administrative cap in the line-item budget detail.

SECTION C – NON-FEDERAL RESOURCES

Enter the non-federal resources. Applicants (with the exception of POL) are required to include non-federal matching funds in an amount equal to $1 for every $5 of federal funds. Non-federal contributions may be in cash or in-kind. In-kind contributions must be fairly evaluated and may include plant, equipment, or services. Amounts provided by the federal government, or services assisted or subsidized to any significant extent by the federal government, may not be included as match. Federal sources may be used as matching funds if received as fees, payments, or reimbursements for the provision of a specific service, such as patient care reimbursements received under Medicare or Medicaid. Generated program income may be used as matching funds.

SECTION E – BUDGET ESTIMATES OF FEDERAL FUNDED NEEDED FOR THE BALANCE OF THE

PROJECT

Enter the federal funds requested for future budget periods within the 3-year project period. Enter the federal request for Year 2 in the (b) First column and Year 3 in the (c) Second column. For the purpose of this application, enter the amount listed in Table 1 for Year 2 and Year 3, with the knowledge that based on Congressional appropriation and subsequent funding distribution negotiations, this value may change from year to year within the project period. The Third and Fourth year columns must remain $0.

SECTION F – OTHER BUDGET INFORMATION (ONLY IF APPLICABLE)

Line 21: Explain amounts for individual object class categories that may appear to be out of the ordinary.

Line 22: Enter the type of indirect rate (provisional, predetermined, final or fixed) that will be in effect during the project period, the estimated amount of the base to which the rate is applied, and the total indirect expense.

Line 23: Provide other explanation as necessary.

The Consolidated Appropriations Act, 2017 (P.L. 115-31), Division H, § 202 states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Please see Section 4.1.iv Budget – Salary Limitation of HRSA’s SF- 424 Application Guide for additional information. Note that these or other salary limitations may apply in FY 2018, as required by law.

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iv. Budget Narrative See Section 4.1.v. of HRSA’s SF-424 Application Guide.

In addition, the NHHCIA program requires a detailed budget narrative in line-item format corresponding with Section B of the SF-424A for the first 12-month period of the 3-year project.

Provide the following information in the Budget Narrative:

• The total resources required to achieve the goals and objectives.

• The expectations regarding federal grant support and maximization of non-grant revenue relative to the proposed plan.

• A detailed presentation of the breakdown and sources for matching funds as required in 42 U.S.C. § 11705(e). This is not a requirement for POL.

• A demonstration of adherence to the 10 percent administrative cap. This is not a requirement for POL.

• For POL only: One-time minor capital needs, defined as the purchase of equipment with a useful life of more than one year and costing more than $5,000.

v. Attachments Please provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Indirect cost rate agreements and proof of non-profit status (if applicable) will not count toward the page limit. Each attachment must be clearly labeled.

Attachment 1: Project Work Plan (Required for POL)

For POL, upload the Project Work Plan for the 3-year project period. Refer to the Response section for details on the required elements. A sample is available at

Attachment 2: Required Service Projections (Required for NHHCS) For NHHCS, upload the Required Service Projections form (see Table 2). Refer to Appendix B for detailed instructions. A sample is available at

Attachment 3: Required Clinical Performance Measures (Required for NHHCS) For NHHCS, upload the Required Clinical Performance Measures forms (see Table 3). Refer to Appendix B for detailed instructions. Required forms are available at

Attachment 4: Optional Clinical Performance Measures (Optional for NHHCS) For NHHCS, upload the Optional Clinical Performance Measures form, as desired (see Table 4). Refer to Appendix B for detailed instructions. Required forms are available at https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/.

https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

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Attachment 5: Required Financial Performance Measures (Required for NHHCS) For NHHCS, upload the Required Financial Performance Measures form (see Table 5). Refer to Appendix B for detailed instructions. Required forms are available at

Attachment 6: Income Analysis Form (Required for NHHCS)

Upload the Income Analysis Form. Refer to Appendix C for detailed instructions.

Required forms are available at

Attachment 7: Staffing Plan (Required for NHHCS and POL)

Upload a staffing plan table that provides a justification for each staff member, including education and experience qualifications, and a rationale for the amount of time being requested for each staff position to be supported under the grant. A sample and instructions are available at

Attachment 8: Position Descriptions for Key Personnel (Required for NHHCS and POL)

Upload position descriptions for key personnel only, including chief executive officer (CEO), chief financial officer (CFO), chief operating officer (COO), and project director (PD). Each position description should be limited to one page and must include the position title; description of duties and responsibilities; position qualifications;

supervisory relationships; salary range; and work hours.

NOTE: This information only has to be provided if it has changed since your last submission to HRSA. If the information has not changed, indicate so for this attachment.

Attachment 9: Biographical Sketches for Key Personnel (Required for NHHCS and POL) Upload biographical sketches for key personnel only, including CEO, CFO, COO, and PD. Biographical sketches should not exceed one page each. When applicable, biographical sketches should include training, language fluency, and experience working with the cultural and linguistically diverse populations to be served, as applicable.

NOTE: This information only has to be provided if it has changed since your last submission to HRSA. If the information has not changed, indicate so for this attachment.

Attachment 10: Current Board Member Characteristics (Required for NHHCS and POL)

Upload the form, including office held, area of expertise, and years of continuous Board service. Required forms are available at

Attachment 11: Letters of Support (Required for NHHCS and POL)

Upload current dated letters of support that specifically indicate commitment to the project (e.g., financial support, in-kind services, staff, space, equipment).

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Attachment 12: Summary of Contracts and Agreements (as applicable) Upload a BRIEF SUMMARY describing project-related contracts and agreements. The summary must address the following items for each contract or agreement:

• Name and contract information for each affiliated agency;

• Type of contract or agreement (e.g., contract, affiliation agreement);

• Brief description of the purpose and scope (i.e., type of services provided, how/where services are provided); and

• Timeframe for each agreement/contract/affiliation.

Attachment 13-15: Other Relevant Documents (as applicable)

Include other relevant documents to support the proposed project plan, including your indirect cost rate agreement, if applicable.

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

System for Award Management

You must obtain a valid DUNS number, also known as the Unique Entity Identifier, for your organization/agency and provide that number in the application. You must also register with the System for Award Management (SAM) and continue to maintain active SAM registration with current information at all times during which you have an active federal award or an application or plan under consideration by an agency (unless the applicant is an individual or federal agency that is exempted from those requirements under 2 CFR § 25.110(b) or (c), or has an exception approved by the agency under 2 CFR § 25.110(d)).

HRSA may not make an award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time HRSA is ready to make an award, HRSA may determine that the applicant is not qualified to receive an award and use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another federal agency, confirm that the registration is still active and that the Authorized Organization Representative (AOR) has been approved.

The Grants.gov registration process requires information in three separate systems:

• Dun and Bradstreet (http://www.dnb.com/duns-number.html)

• System for Award Management (SAM) (https://www.sam.gov)

• Grants.gov (http://www.grants.gov/)

For further details, see Section 3.1 of HRSA’s SF-424 Application Guide.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

http://www.dnb.com/duns-number.html https://www.sam.gov/ http://www.grants.gov/

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4. Submission Dates and Times

Application Due Date The due date for applications under this NOFO is April 20, 2018 at 11:59 p.m. Eastern Time.

See Section 8.2.5 – Summary of emails from Grants.gov of HRSA’s SF-424 Application Guide for additional information.

5. Intergovernmental Review NHHCIA is not a program subject to the provisions of Executive Order 12372, as implemented by 45 CFR Part 100.

6. Funding Restrictions

You may request funding for a project period of up to 3 years, at no more than the amount listed in Table 1 per year (inclusive of direct and indirect costs).