oppHRSA-18-032-cfda93.211-cidHRSA-18-032-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy Office for the Advancement of Telehealth

Evidence-Based Tele-Behavioral Health Network Program

Funding Opportunity Number: HRSA-18-032

Funding Opportunity Types: New, Competing Continuation Catalog of Federal Domestic Assistance (CFDA) Number: 93.211

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: June 25, 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: May 9, 2018

Kerri Cornejo Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-4204 Fax: (301) 443-2803 Email: kcornejo@hrsa.gov

Authority: Section 711(b) of the Social Security Act (42 U.S.C. 912(b)), as amended.

mailto:kcornejo@hrsa.gov

HRSA-18-032 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP), Office for the Advancement of Telehealth is accepting applications for the fiscal year (FY) 2018 Evidence-Based Tele-Behavioral Health Network Program. The two-fold purpose of this program is to use telehealth networks to increase access to behavioral health care services in rural and frontier communities and to conduct evaluations of those efforts to establish an evidence-base for assessing the effectiveness of tele-behavioral health care for patients, providers, and payers.

Funding Opportunity Title: Evidence-Based Tele-Behavioral Health Network Program

Funding Opportunity Number: HRSA-18-032

Due Date for Applications: June 25, 2018

Anticipated Total Annual Available FY18 Funding:

$4,900,000

Estimated Number and Type of Awards: Up to 14 cooperative agreements

Estimated Award Amount: Up to $350,000 per year

Cost Sharing/Match Required: No

Project Period/Period of Performance: September 1, 2018 through August 31, 2021) (3 years)

Eligible Applicants: Eligible applicants include domestic public or private, non-profit entities.

Faith-based and community-based organizations, tribes, and tribal organizations are eligible to apply.

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), 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/

HRSA-18-032 ii

Technical Assistance

HRSA has scheduled the following technical assistance webinar:

Webinar

Day and Date: Thursday, May 24, 2018 Time: 3 – 4 p.m. ET Call-In Number: 1-888-329-8895 Participant Code: 738161 Weblink: https://hrsa.connectsolutions.com/ta_bhnpg_application/ https://hrsa.connectsolutions.com/ta_bhnpg_application/

HRSA-18-032 iii

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

HRSA-18-032 1

I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Evidence-Based Tele-Behavioral Health Network Program (EB-THNP). The two-fold purpose of this program is to use telehealth networks to increase access to behavioral health care services in rural and frontier communities and to conduct evaluations of those efforts to establish an evidence-base for assessing the effectiveness of tele-behavioral health care for patients, providers, and payers.

The range and use of telehealth services have expanded over the past decades, along with the role of technology in improving and coordinating care. Traditional models of telehealth involve care delivered to a patient at an originating (or spoke) site from a specialist working at a distant (or hub) site. A telehealth network consists of a series of originating sites receiving services from a collaborating distant site. For the purposes of this NOFO, telehealth is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Telehealth modalities to be used to support clinical treatment may include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

The Evidence-Based Tele-Behavioral Health Network Program presents an opportunity to address two clinical priorities: mental health and substance abuse (particularly the opioid abuse epidemic). Approximately 1 in 5 adults, or 18.1 percent of the U.S.

population over the age of 18, have a mental illness.1 When considering serious mental illness, an illness categorized by distinct mental health disorders that result in functional impairment, roughly 9.8 million adults (over the age of 18) are affected.2 Research funded by HRSA found that a higher percentage of individuals with serious mental illness are located in nonmetropolitan (rural) counties than in metropolitan (urban) counties.3

Additionally, deaths from drug-related overdoses in the United States have risen. While deaths from drug overdose have increased by 11.4 percent between 2014 and 2015, 1 Rural Health Reform Policy Research Center. The 2014 Update of the Rural-Urban Chartbook. October 2014.

https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf. Accessed October 2017. Defined according to two dimensions: 1) presence of a diagnosable mental, behavioral, or emotional disorder in the last year (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified in the DSM-IV; and 2) the level of interference with or limitation of one or more major life activities resulting from a disorder (functional impairment).

2Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the

2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). 2015.

http://www.samhsa.gov/data/. Accessed October 2017.

3Rural Health Reform Policy Research Center. The 2014 Update of the Rural-Urban Chartbook. October 2014.

https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf. Accessed October 2017.

https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf

HRSA-18-032 2

the rate of opioid-related deaths increased 15.6 percent.4 Rural residents face an even greater disparity as rural states are more likely to have higher rates of overdose deaths, specifically from prescription opiate overdoses.5

Rural residents often have difficulty accessing behavioral health care providers. HRSA-funded research has found that nationally, the per capita supply of behavioral health providers in non-metropolitan counties is significantly less than the supply in metropolitan counties. For example, there is approximately one-third the supply of psychiatrists per capita and less than half the per capita supply of psychologists in non-metropolitan counties as there are in metropolitan counties. Of the 284 U.S. counties without behavioral health providers (psychiatrists, psychologists, social workers, psychiatric nurse practitioners and counselors) in 2015, 252 (89 percent) are considered rural.6

While the Evidence-Based Tele-Behavioral Health Network Program seeks to expand access to services for rural patients, its primary goal is to significantly contribute to the evidence base for assessing the effectiveness of tele-behavioral health care services for patients, providers, and payers. This will be accomplished through collaboration and systematic data collection by the awardees and analysis by HRSA’s Telehealth- Focused Rural Health Research Center7 recipient. By aggregating data from the entire cohort of awardees, researchers will have a sufficient sample size to conduct statistically sound analyses.

2. Background

This program is authorized by Section 711(b) of the Social Security Act (42 U.S.C.

912(b)), as amended.

HRSA, an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable. HRSA’s mission is to improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs. Additional information about HRSA can be found at:

https://www.hrsa.gov/.

HRSA’s Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within the Department of Health and Human Services (HHS). FORHP plays

4 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: December 2016. DOI:

http://dx.doi.org/10.15585/mmwr.mm6550e1. Accessed September 2017.

5 National Advisory Committee on Rural Health and Human Services, Families in Crisis: The Human Service

Implications of Rural Opioid Misuse. 2016.

https://www.hrsa.gov/advisorycommittees/rural/publications/opioidabuse.pdf. Accessed September 2017.

6 WWAMI Rural Health Research Center. Supply and Distribution of the Behavioral Health Workforce in Rural

America. September 2016. http://depts.washington.edu/fammed/rhrc/wp-content/uploads/sites/4/2016/09/RHRC_DB160_Larson.pdf. Accessed October 2017.

7 https://www.ruralhealthresearch.org/centers/telehealth https://www.hrsa.gov/ https://www.hrsa.gov/advisorycommittees/rural/publications/opioidabuse.pdf http://depts.washington.edu/fammed/rhrc/wp-content/uploads/sites/4/2016/09/RHRC_DB160_Larson.pdf http://depts.washington.edu/fammed/rhrc/wp-content/uploads/sites/4/2016/09/RHRC_DB160_Larson.pdf

HRSA-18-032 3

two distinct but complementary roles within HHS. The first is to advise the Secretary on rural policy issues across the Department, including interactions with the Medicare and Medicaid programs, and support policy-relevant research on rural health issues. The second is to administer grant programs focused on supporting and enhancing health care delivery in rural communities. By locating both functions in the same office, FORHP is able to use its policy role to inform the development of grant programs and its grant role to provide community-level perspective when assessing the impact of HHS policy on rural areas. Information about current FORHP telehealth programs is located on the FORHP website: https://www.hrsa.gov/rural-health/index.html.

Applicants are encouraged to collaborate with other entities who receive HRSA funding for behavioral health care services, such as Federally Qualified Health Centers that received Access Increases in Mental Health and Substance Abuse Services (AIMS) supplemental funding. Applicants are also encouraged to collaborate with grantees of the Substance Abuse and Mental Health Services Administration (SAMHSA) or other federal funding sources, to avoid duplication of effort and enhance the services that patients receive. More information about the most recent HRSA/AIMS recipients can be found here:

https://bphc.hrsa.gov/programopportunities/fundingopportunities/aims/fy2017awards/ind ex.html.

II. Award Information

1. Type of Application and Award

Types of applications sought: New, Competing Continuation.

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where substantial involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

HRSA Program involvement will include:

Reviewing and providing recommendations on the final work plan;

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

Participating in conference calls or meetings with the awardees;

Supporting collaboration between the Evidence-Based Tele-behavioral Health Network program awardees and the Telehealth-Focused Rural Health Research Center awardee;

Providing common measures that must be reported by all recipients;

Reviewing products or publications before dissemination;

https://www.hrsa.gov/rural-health/index.html https://bphc.hrsa.gov/programopportunities/fundingopportunities/aims/fy2017awards/index.html https://bphc.hrsa.gov/programopportunities/fundingopportunities/aims/fy2017awards/index.html

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Reviewing reimbursement requests for tele-behavioral health services that cannot be reimbursed by third party payers; and

Reviewing and providing recommendations regarding additional uses of the telehealth network beyond behavioral health care services. This may include using the network and related telehealth technologies for provider education or to provide clinical services for patients beyond tele-behavioral health care.

The cooperative agreement recipient’s responsibilities will include:

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

Completion of activities included in the final approved work plan, specifically data collection and active participation in HRSA-funded efforts to contribute to the tele-behavioral health evidence base;

Participation in conference calls or meetings with HRSA;

Collaboration with HRSA in ongoing review of activities and budgets; and

Timely response to requests for information, including requests for data submissions, from HRSA or the Telehealth-Focused Rural Health Research Center awardee.

2. Summary of Funding

HRSA expects approximately $4,900,000 to be available annually to fund up to 14 recipients. You may apply for a ceiling amount of up to $350,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 1, 2018 through August 31, 2021 (3 years). Funding beyond the first year is dependent on the availability of appropriated funds for the Evidence- Based Behavioral Health Telehealth Network 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.

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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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public or private, non-profit entities. Faith-based and community-based organizations, tribes, and tribal organizations are eligible to apply. Network members may be public, private, nonprofit or for-profit entities that provide services to rural areas.

Organizations applying to this NOFO should be experienced telehealth providers and, should design their proposed projects to maximize the number of individuals receiving tele-behavioral health services in rural areas. Applicants should select rural network partners with whom they have the ability to obtain de-identified patient level clinical and cost data for patients receiving telehealth as well as appropriate control groups.

Any application received from a current Telehealth-Focused Rural Health Research Center award recipient will not be considered for funding under this notice.

Important: Applicants should have a successful track record in implementing telehealth technology and have a network of partners in place and committed to the project as of the date of application. Signed Memoranda of Agreement from those network partners committed to the proposed project must be included in the application. Applicants failing to submit verifiable information with respect to the commitment of network partners, including specific roles, responsibilities, and clinical services to be provided, will not be funded. Applicants who receive funding from HRSA for this program but fail to bring on board network partners as indicated in their application may receive a reduction in award in future funding years. In addition, applicants who do not have the necessary assurances and infrastructure to provide de-identified patient clinical and cost data, and associated control data will not be considered for funding.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Applications that exceed the ceiling amount will be considered non-responsive and will not be considered for funding under this notice.

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.

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, HRSA-18-032 6 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. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) or workspace application. This allows Grants.gov to email organizations in the event HRSA changes and/or republishes the NOFO 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 For Applicants 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. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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 80 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 workspace application do not count in the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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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 Attachment 11: 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.

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:

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

Succinctly (1-2 pages) describe the purpose of the proposed project. Include an overview of the telehealth network and collaborative plans for addressing the behavioral health care needs in the rural communities in your proposed service area, including a list of the specific services that will be offered via telehealth. You must include a data-driven estimate of the projected number of sites and unduplicated patients that will receive services and for whom data (including clinical and cost data) will be collected for research/evaluation purposes for each year of the project period. Do not include information about network sites or patients who would not be active contributors or beneficiaries under this cooperative agreement. For example, if your network includes 10 sites but only eight sites will be actively participating/providing data in the proposed project, you should only discuss those eight sites in your application.

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NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 (Need) This section should outline need from two perspectives:

Tele-Behavioral Health Evidence Base Describe how the proposed tele-behavioral health services can contribute to or add to the existing evidence-base around the effectiveness of tele-behavioral health care for patients, providers, and payers. Specifically, briefly describe what you see as the gaps or weaknesses in the existing evidence-base for tele-behavioral health services. Discuss how information collected in this program could be analyzed to address the identified gaps and impact the field of telehealth.

Community and Provider Need for Tele-Behavioral Health Services Describe the community and provider needs for tele-behavioral health services in your proposed rural network. Present evidence of significant demand for tele-behavioral health services among patients and providers in the proposed network’s service area. The target population of the project must be sufficiently large to permit rigorous data analysis (e.g., projects should not propose limited services to small demographic groups or uncommon clinical conditions).

Quantitative data must be used when describing the demand for tele-behavioral health services.

METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 (Response) and #4 (Impact) This section should describe how tele-behavioral health services will be delivered to the target population in the proposed project in a manner that permits rigorous analysis and data collection but also promotes increased access to care. Include a discussion of the following:

A. Based on the information provided in the “Needs Assessment” section, describe the tele-behavioral health services that you will offer to each network site under this award and the technical means by which they will be delivered;

B. Provide a clear explanation and justification of how proposed network sites were selected for this application and how they will collaborate with you to maximize the number of patient encounters and individuals for whom data can be collected and analyzed in a statistically rigorous manner;

C. Describe the relationship and data sharing capabilities between your organization (the distant) and the originating (network) sites;

D. Discuss and demonstrate the willingness of the administrators, providers, and community members at the network sites to deliver/receive behavioral health care using telehealth technology;

E. Discuss the telehealth reimbursement environment for behavioral health care services and if Medicare, Medicaid, and/or private insurance in the applicant state(s) cover the proposed services;

F. Describe the technology requirements and each type of equipment that will be employed along with its relevance to the project, how it contributes to cost-effective and quality care, and ease of use; and

G. Describe plans and activities to implement the technology with assurances that the technology complies with existing federal and industry standards, HRSA-18-032 9 that the technologies are interoperable, and that the proposed technology can be easily integrated into health care practice.

WORK PLAN -- Corresponds to Section V’s Review Criteria #2 (Response) and #4 (Impact) This section should describe the specific steps that you will take to: (1) increase access to behavioral health care services in rural and frontier communities; (2) contribute to the evidence base assessing the effectiveness of tele-behavioral health care services for patients, providers, and payers; and (3) effectively manage the project. The discussion should include goals, objectives, and the following:

Increase Access to Behavioral Health Care Services

A. Describe how tele-behavioral health care services will be implemented in the network (originating) sites (e.g., scheduling, identifying potential patients, educating staff and providers on how to integrate telehealth services into existing workflows, etc.); and

B. Provide a timeline with specific milestones for each site.

Contribute to the Evidence Base A. Provide a detailed explanation of how data will be collected from the originating sites (e.g., manual chart abstraction, extraction from electronic health records, etc.);

B. Provide an explanation of data quality control processes; and C. Provide an explanation of internal review board and/or data use agreement processes.

Project Management A. Provide a detailed explanation of how your organization will actively manage this project to ensure that all aspects of the project (both care delivery and data collection) are proceeding effectively.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#4 (Impact) This section should identify challenges that you may encounter in designing and implementing the activities described in your work plan and the approaches that you will use to resolve those challenges. These challenges may include those related to the provision of tele-behavioral health services or to the required data collection and cross-program evaluation and analysis. You should consider scenarios including:

A. Staff turnover and/or loss of telehealth champion(s) at network sites;

B. Broadband and other infrastructural issues related to providing telehealth services to network sites;

C. Addressing underutilization of tele-behavioral health services in network sites;

D. Data collection from network sites; and E. Need for technical assistance at the originating (network) sites to optimize the provision of tele-behavioral health care services.

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EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria #3 (Evaluative Measures) and #5 (Resources/Capabilities) This section should demonstrate your organization’s capability to collaborate (including data sharing) with the Telehealth-Focused Rural Health Research Center on across-awardee program evaluation/analyses designed to contribute to the tele-behavioral health evidence base. HRSA will provide awardees with a full list of required measures at the beginning of the project period. For the purposes of your application, you must demonstrate the ability and capacity to report on measures in the following domains:

A. Clinical outcomes (e.g., symptom reduction or reduction in condition severity at six months as measured by standardized psychiatric assessment scales appropriate for the population being treated such as the Patient Health Questionnaire – 9 and the Beck Depression Inventory);

B. Functional improvement (e.g., quality of life as measured through pre/post improvement using scales such as the World Health Organization Disability Assessment Schedule 2.0 and/or the Short Form -12 Health Survey);

C. Cost and cost-effectiveness/minimization (e.g., reduced treatment costs relative to non-telehealth treatment based on fixed and variable costs and reduced travel time; reduced utilization of other health services such as emergency departments or hospitalizations);

D. Quality of care (e.g., performance measures such as timely outpatient visit following hospital discharge, improved use of validated screening tools such as the Patient Health Questionnaire – 9 for earlier identification and diagnosis, or improvement in Working Alliance Inventory scores); and

E. Access (e.g., reduced wait time until appointment and increased receipt of follow-up specialty services; reduced travel time for patients).

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 (Resources/Capabilities) This section should describe your organization’s structure and the proposed staffing plan for activities conducted under this notice.

A. Describe your organization’s experience (including materials published) successfully conducting work of a similar nature;

B. Demonstrate previous experience successfully executing data-sharing and/or research activities that required your organization to gather data, either through manual chart abstractions or electronic health records, from the network partner sites;

C. Describe the availability of behavioral health providers available, either directly employed by your organization or employed via contract with your organization, that have the capacity to provide telehealth services to the network partners (spoke/originating sites) within 60 days of the project start date;

D. Describe the ability of the network member sites (spoke sites) to implement the project, including their ability to expand on existing provider and community support for tele-behavioral health services;

E. Describe the network governance, including the ability of your organization (hub site) to hold network (spoke) sites accountable for data delivery and other project deliverables; and

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F. Describe how the information provided in the Project Organizational Chart (Attachment 4) contributes to the ability of the network to conduct the program requirements and meet program expectations.

In addition, each partner (spoke site) within the project should:

G. Have a clearly defined role and specific set of responsibilities for the project; and

H. Have a signed and dated Memoranda of Agreement (Attachment 3) that delineates the member’s role and resource contribution, and decisions on equipment placement and responsibility for maintenance throughout the funding period and beyond.

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

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response and (4) Impact

Resolution of Challenges (4) Impact

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget, Detailed Budget and Budget Narrative (below)

(6) Support Requested – the budget section, including the detailed budget and the budget narrative, should include sufficient justification to allow reviewers to determine the reasonableness of the 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.

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 HRSA selects the application for funding, you will have a well-organized plan

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and by carefully following the approved plan can avoid audit issues during the implementation phase.

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 Evidence-Based Tele-Behavioral Health Network Program requires that you submit a separate program-specific Detailed Budget (described below) for each year of the project period (September 1, 2018 to August 31, 2021) and upload it as Attachment 7. The detailed budget should reflect allocations for each 12-month budget period. More information on the detailed budget is described in the following section:

Detailed Budget

The detailed budget should be included as Attachment 7.

Detailed budget information is required to capture information specific to the proposed telehealth activities. It provides a detailed breakout of how each network site will expend funds requested for each object class category. The Detailed Budget allows you to identify how you will use federal funds for each proposed site within the network.

The initial budget period for this funding opportunity is from September 1, 2018 to August 31, 2019. You must provide a budget for each year of requested funding for each object class category that reflects the cost of proposed activities for each network member/site. Based on the budget for each object class category, you will develop a consolidated budget.

Each object class category should be reported on a separate page (or multiple pages if needed based on the number of network sites). Report the object class categories as follows:

A. Personnel/Fringe Benefits;

B. Travel;

C. Equipment;

D. Supplies;

E. Subcontracts;

F. Other; and G. Indirect Costs.

Each page should identify the object class category and the name of the applicant and network member site. For each site, indicate if it is located in an urban area or a rural area (see Attachment 6 for rural definition). All network sites (originating sites) must be located in a rural area. The hub site/distant site(s) may be located in an urban area.

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Combined Object Class Totals: On one page, using the identical format for the detailed budget discussed above, summarize federal and non-federal costs for combined costs of all object classes for the Applicant and each Network Member Site. Please include indirect costs in the summary worksheets when calculating these totals.

We recommend that you present your line-item budget in table format, listing each object class category for each facility (starting with your organization as the hub site and the subsequent network member sites/spoke sites) on the left side of the document, and the program corresponding costs (OAT- Federal Dollars, Other Federal Dollars, Federal Subtotal, Applicant/Network Partners Non-Federal Dollars, State Non- Federal Dollars, Other Non-Federal Dollars, Non-Federal Subtotal Dollars, and Total Dollars) across the top. Please label each site as being rural or urban.

As a reminder, only network sites that will be actively participating and contributing data should be listed and all network partner sites (spoke sites) must be located in rural areas. Under Personnel, please list each position by the position title and name, with annual salary, Full-time Equivalent (FTE), percentage of fringe benefits paid, and salary charged to the award for each site. Equipment should be listed under the name of the site where the equipment will be placed. List the types of equipment to be funded at each site. Only equipment costs should be listed here (personnel costs for equipment installation should be listed in the “Other” category).

Equipment expenditures under this funding opportunity are limited to a 40 percent cap per year.8 Clinician payments should be listed in the “Other” category and should only be included for patients for whom no alternate reimbursement is available.

Indirect costs are for the applicant organization only. The amount requested on the SF-424A and the amount listed on the detailed budget must match. It is recommended that Attachment 7 be converted to a PDF to ensure page count does not change when the document is uploaded into https://www.grants.gov.

For Revenues by Site (for the budget period): On a single separate page, report as two vertical columns. The left column should list each Network site starting with the Applicant site on the top followed downward by each Network Member Site; and the right column should list the anticipated revenue total corresponding to each Applicant/Network Member site. Include this document in Attachment 7.

Treatment of Program Income: Under the Telehealth Network Program, any program income, including reimbursements from third party claims per Section IV.2.iv. Budget Narrative, should be added to funds committed to the project and used to further eligible program objectives.

8 This restriction is consistent with similar programs funded through HRSA.

https://www.grants.gov/

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Transmission Costs: Award dollars may be used to pay for transmission costs, such as the cost of broadband directly related to the purposes of the project. However, EB-THNP network members that request support for transmission costs also apply for support from the Universal Service Rural Health Care Program or document why they are not eligible for Universal Service support. For additional information, see the Universal Service Administrative Company (USAC) web site at http://www.usac.org/rhc/.

Clinician Payments: Applicants must seek third-party reimbursement for services, if applicable. More than 40 state Medicaid programs now reimburse some level of telehealth services. In addition, some states have instituted “parity laws” for telehealth, meaning that if an insurer covers a service face-to-face it must provide the same reimbursement for the service via telehealth. Applicants for EB-THNP services that could be reimbursed by Medicaid, Children’s Health Insurance Programs (CHIP), Medicare or private insurance should highlight their ability to catalyze a sustainable network through their state’s reimbursement environment. More information about state-specific telehealth reimbursement can be found here:

https://www.umtrc.org/updated-state-telehealth-laws-and-reimbursement-policies.

Note applicants may allocate funding from the award to pay practitioners for telehealth services only after documenting that the awardee has attempted to seek third-party reimbursement and/or why it is not possible to receive third party reimbursement. Awardees seeking to use award dollars to pay practitioners for tele-behavioral health services will work with HRSA post-award to determine the maximum allowable payment.

Allowable Costs

Award funds may be used for salaries, equipment, and operating or other costs, including:9 A. Developing and delivering clinical telehealth services that enhance access to behavioral health care services in rural and frontier communities;

B. Developing and acquiring, through lease or purchase, computer hardware and software, audio and video equipment, computer network equipment, interactive equipment, data terminal equipment, and other equipment that furthers the objectives of the telehealth network program;

C. Developing and acquiring instructional programming;

D. Providing for transmission of medical data, and maintenance of equipment;

E. Providing for compensation (including travel expenses) of specialists, and referring health care providers, who are providing rural telehealth services through the telehealth network, if third party payment is not available for the telehealth services delivered through the telehealth network;

F. Developing projects to use telehealth technology to facilitate collaboration between rural health care providers; and

G. Collecting and analyzing usage statistics and data to document the cost-effectiveness of telehealth services and answer similar research questions that will contribute to the evidence-base for rural tele-behavioral health care.

9 The allowable costs are consistent with similar programs funded through HRSA.

http://www.usac.org/rhc/ https://www.umtrc.org/updated-state-telehealth-laws-and-reimbursement-policies

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The Consolidated Appropriations Act, 2018 (P.L. 115-141), 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.” 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 2019, as required by law.

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

In addition, the EB-THNP requires the following in the budget narrative:

Program Income: Discuss the planning assumptions used to determine the amount of estimated program income indicated in the total project budget (if applicable).

Program income is defined as gross income – earned by a recipient, sub-recipient, or contractor under a grant – directly generated by the award-supported activity or earned as a result of the award.

Third Party Telehealth Payment: Describe third party telehealth payment opportunities for the respective state(s) and program(s) for the proposed network sites. You should demonstrate awareness of evolving policies regarding reimbursement for telehealth services and monitor policy changes during the award period. As indicated in the previous section, you may allocate funding from the award to pay practitioners for telehealth services, only after documenting that you have attempted to seek third-party reimbursement and/or why it is not possible to receive third party reimbursement. Awardees seeking to use award dollars to pay practitioners for tele-behavioral health services will work with HRSA post-award to determine the maximum allowable payment.

v. Attachments 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. You must clearly label each attachment.

Attachment 1: Staffing Plan and Job Descriptions for Key Personnel (see Section

4.1. of HRSA’s SF-424 Application Guide) [required]

Keep each job description to no more than one page in length. Include the role, responsibilities, and qualifications of proposed project staff. Include key personnel that are located at the network sites (originating sites). If people will be hired to fill positions with HRSA funding, provide position descriptions that give the title of the position, duties and responsibilities, required qualifications, supervisory relationships, and salary ranges.

Attachment 2: Biographical Sketches of Key Personnel [required]

Include biographical sketches for people occupying the key positions described in Attachment 1, not to exceed one page in length per person. Do not submit a full curriculum vitae. Highlight the qualifications (including education and past experience) that each person has to carry out his/her respective role. In the event http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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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.

Attachment 3: Memoranda of Agreement [required, not counted in page limit] Provide documentation that describes the working relationships between the applicant organization and each network member included in the application for this NOFO. Each memorandum of agreement (MOA) shall be executed by the listed contact in the application or other appropriate official from the network member (originating) site with authority to obligate the site to the project. The MOA will include a cover page on the letterhead of each respective network member (originating) site. The MOA should be tailored to the particular network member site and contain, at minimum, the following:

Clearly defined roles and a specific set of responsibilities for the project (including decisions about equipment placement, ownership and maintenance of equipment throughout the project period, and data collection)

Clearly defined resources (e.g., space, staff, access to data, etc.)

Past and current activities in planning and implementing telehealth projects with your (the applicant) organization

All MOAs must be dated and contain original signatures from the authorized representatives. MOAs containing generic information not referencing and relevant to the proposed EB-THNP project are not acceptable.

Note: Evidence must be provided that all network partners are committed to the project and are ready to begin implementing the project on September 1, 2018.

Applicants failing to submit verifiable information with respect to the commitment of network partners, including specific roles, responsibilities, and services being provided, will be deemed incomplete and will not be considered for funding.

Attachment 4: Project Organizational Chart [required]

Provide a one-page figure that depicts the organizational structure of the project, including subcontractors and other significant collaborators (including HRSA and HRSA’s Telehealth Focused Rural Health Research Center). The chart should illustrate where project staff are located and reporting lines for each component of the project.

Attachment 5: Indirect Cost Rate Agreement [if applicable]

Information on HHS indirect cost rates can be obtained from the Office of the Assistant Secretary for Administration and Management - Program Support Center at https://rates.psc.gov/

Attachment 6: Network Identification Information [required]

You are required to submit the following information about your organization and the network member sites included in your application.

A. The applicant site (your organization)

a. Site name and address

b. Designation as a hub/distant site or spoke/originating site

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c. National Provider Identifier and Primary Taxonomy (if the site bills for services)10

d. HCP number (if the site receives Universal Service funding)11

e. County where the organization is located

f. Rural or urban geographic designation12

g. Description of facility

i. Federally Qualified Health Center or other Community Health Center

ii. Entity operating a clinic, including a Rural Health Clinic

iii. Hospital, including Critical Access Hospitals

iv. Local health department

v. Other publically funded health or social service agency

vi. Long term care provider

vii. Provider of outpatient mental health services or entity operating an outpatient mental health facility

viii. Local or regional emergency health care provider

ix. Institution of higher education

x. Other entity not otherwise described (please provide description) B. Successive network member sites

Successive pages of information should be used to identify each…