oppHRSA-18-063-cfda93.127-cid7146-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Child, Adolescent and Family Health

Emergency Medical Services for Children

State Partnership Program

Funding Opportunity Number: HRSA-18-063 Funding Opportunity Type(s): New, Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number: 93.127

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: January 8, 2018

MODIFIED on November 16, 2017:

Rescheduled TA Call, Updated Application Package and Guide

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: November 3, 2017

Theresa Morrison-Quinata Branch Chief, Emergency Medical Services for Children Telephone: (301) 443-1527 Email: TMorrison-Quinata@hrsa.gov

Authority: Public Health Service Act, Title XIX, § 1910, as amended (42 U.S.C. 300w-9).

mailto:TMorrison-Quinata@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Division of Child, Adolescent and Family Health (DCAFH) is accepting applications for the Emergency Medical Services for Children State Partnership (EMSC SP) Program. The purpose of this Program is to expand and improve emergency medical services for children who need treatment for trauma or critical care. This Program will provide funding for demonstration projects in each state and jurisdiction in the United States (U.S.) for the expansion and improvement of state EMS systems that respond to and care for children in emergencies involving trauma or critical care.

Recipients will demonstrate new models of EMS system and patient outcome improvements for children by testing innovative methods to promote electronic health information systems; coordination of pediatric emergency care; increased education for the emergency workforce; integration of pediatric components in emergency systems;

and national quality improvement (QI) initiatives.

The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner. Applicants should note that this program may be cancelled prior to award recommendations.

Funding Opportunity Title: Emergency Medical Services for Children State Partnership Program

Funding Opportunity Number: HRSA-18-063

Due Date for Applications: January 8, 2018

Anticipated Total Annual Available FY2018 Funding: $7,670,000

Estimated Number and Type of Award(s): Up to 59 grants Estimated Award Amount: Up to $130,000 per year Cost Sharing/Match Required: No

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

Eligible Applicants:

State governments and accredited schools of medicine in states and jurisdictions.

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/.

Technical Assistance

The HRSA EMSC Program invites you to a Technical Assistance Webinar.

Day and Date: Wednesday, November 15, 2017 – RESCHEDULED Time: 4 p.m. ET Call-In Number: 1-888-566-5969 Participant Code: 7586629# Weblink: https://hrsa.connectsolutions.com/emsc-sp-hrsa-18-063/

RESCHEDULED WEBINAR

Day and Date: Tuesday, November 21, 2017 Time: 4 p.m. ET Call-In Number: 1 888-946-8383 Participant Code: 6305078# Weblink: https://hrsa.connectsolutions.com/emsc-sp-hrsa-18-063/

You may also write to HRSAEMSC@hrsa.gov for the recorded webinar link within 2 days of the technical assistance webinar.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/emsc-sp-hrsa-18-063/ https://hrsa.connectsolutions.com/emsc-sp-hrsa-18-063/ mailto:HRSAEMSC@hrsa.gov

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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. Program-Specific Forms

vi. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Emergency Medical Services for Children State Partnership Program.

The Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Division of Child, Adolescent and Family Health is accepting applications for the Emergency Medical Services for Children State Partnership (EMSC SP) Program. This Program will provide funding for demonstration projects in each U.S.

state and jurisdiction for the expansion and improvement of state emergency medical services (EMS) for children who need treatment for trauma or critical care. Through state, national, and federally coordinated efforts, the EMSC SP Program will systematically improve the delivery and quality of emergency care to improve patient outcomes, thus reducing pediatric morbidity and mortality. Recipients will demonstrate new models of EMS system and patient outcome improvements for children by testing innovative methods to promote electronic health information systems; coordination of pediatric emergency care; increased education for the emergency workforce;

integration of pediatric components in emergency systems, and national quality improvement (QI) initiatives aimed to improve health outcomes. Each grant recipient will work to achieve the following EMSC SP Program objectives, which are designed to monitor and measure impact at the state/jurisdiction level and are in alignment with established targets for the Program’s performance measures:

1) By 2020, increase to 30 percent the proportion of EMS agencies that have a designated individual responsible for the coordination of pediatric emergency care.

2) By 2020, increase to 30 percent the proportion of EMS agencies that evaluate EMS practitioners' pediatric skills at least once per year.

3) By 2021, increase to 80 percent the proportion of EMS agencies that collect and submit uniform data to the National EMS Information System.1

4) By 2022, increase by 10 points from 2016 baseline the average National Pediatric

Readiness Assessment (NPRA) score of the state/jurisdiction’s hospital emergency departments.2

1 The National EMS Information System collects data from pre-hospital EMS providers which are used to monitor patient care in a systematic way to improve pediatric performance and outcomes.

2 A subpanel of experts from the national steering committee was assembled to develop weighting criteria for the National Pediatric Readiness Assessment. Based on the results of the expert panel and the California Readiness Project, 24 of the questions were weighted in the national assessment to generate an overall weighted pediatric readiness score (WPRS) for each hospital. The WPRS was normalized to a 100-point scale. The final weighting for each section for the national assessment included 19 points for coordination of care, 10 points for physician/nurse staffing, 7 points for quality improvement, 14 points for patient safety, 17 points for policies/procedures, and 33 points for equipment and supplies. The national median score in 2013 was 69.

http://www.nemsis.org/

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5) Achieve the following improvements within hospital systems:

• By 2022, increase to 25 percent the proportion of hospitals recognized as part of a statewide, territorial, or regional standardized program that are able to stabilize and manage pediatric medical emergencies;

• By 2022, increase to 50 percent the proportion of hospitals recognized as part of a statewide, territorial, or regional standardized program that are able to stabilize and manage pediatric trauma;

• By 2021, increase to 90 percent the proportion of hospitals that have written inter-facility transfer guidelines that cover pediatric patients and that include specific components of transfer; and

• By 2021, increase to 90 percent the proportion of hospitals that have written inter-facility transfer agreements that cover pediatric patients.

6) Annually demonstrate:

• Permanence of pediatric EMS in the state/jurisdiction EMS systems; and

• Integration of EMSC priorities into hospital/health care facility statutes or regulations.

7) By 2022, engage in at least one QI collaborative designed to improve pediatric outcomes.

EMSC SP Program Activities:

The EMSC SP Program will collaborate with key EMS stakeholders to demonstrate the effectiveness of the following activities:

Activity 1: Facilitate a multi-disciplinary state/jurisdiction EMSC Advisory Committee, ensuring representation of the eight core required members3 to:

• Provide advice to the recipient regarding the activities of the EMSC SP Program, including key strategies to improve EMSC Performance Measures.

• Recommend opportunities for sustainable integration of unique pediatric considerations within the state/jurisdiction’s EMS system.4

• Assure representation from families whose children have accessed the EMS system due to a medical emergency.

Activity 2: Collaborate with pre-hospital EMS agencies and key stakeholders to:

• Promote, support, and facilitate the coordination of pediatric emergency care, including the designation of an individual within pre-hospital EMS agencies responsible for pediatric coordination.

• Promote the submission of patient care data to electronic health information systems, ensuring that pre-hospital EMS agencies collect and submit uniform data to the National EMS Information System for all 911 emergency calls.

3 EMS for Children Performance Measures: Implementation Manual for State Partnership Grantees.

(2017). National EMSC Data Analysis Resource Center. Retrieved from http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Manual%20Web_ 0217.pdf. Page 75.

4 EMS for Children Performance Measures: Implementation Manual for State Partnership Grantees.

(2017). National EMSC Data Analysis Resource Center. Retrieved from http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Manual%20Web_ 0217.pdf. Pages 90-91.

http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Manual%20Web_0217.pdf http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Manual%20Web_0217.pdf http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Manual%20Web_0217.pdf

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• Improve the readiness of pre-hospital EMS agencies to care for children.

Activity 3: Collaborate with Hospital Emergency Departments and key stakeholders to:

• Increase the proportion that conduct continuous QI through the National

Pediatric Readiness Project (NPRP).

• Address pediatric readiness gaps identified through the NPRP.

• Ensure that pediatric needs are specifically addressed in hospital preparedness plans.

• Engage with and support state health care coalitions, in partnership with the

Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program.

• Develop pediatric medical recognition systems that ensure facilities are prepared to care for children in both medical and traumatic events.

Activity 4: Collaborate with both pre-hospital and hospital emergency departments to:

• Promote, support, and facilitate education/training for the emergency workforce to include, but not limited to the correct protocol and equipment for optimal pediatric treatment.

• Address gaps in the EMS system.

Activity 5: Participate in EMSC QI collaboratives led by HRSA, the EMSC Innovation and Improvement Center, and the National EMSC Data Analysis Resource Center. The use of QI strategies provides an opportunity to see the incremental benefits of your efforts. The focus of the EMSC QI collaboratives will be determined by several factors, such as the prevalence of pediatric acute illness or severe injury within the states/jurisdictions and HRSA priorities. Examples of topics to be addressed through EMSC QI collaboratives include:

• the EMS Compass5 Performance Measures on Pediatric Respiratory or Medication Error.

• Hospital Preparedness Program6 pediatric-focused initiatives.

• National Pediatric Readiness Project7 components of facility preparedness to care for children.

Activity 6: Collect and report EMSC performance measure data.

2. Background

The HRSA EMSC Program is authorized by the Public Health Service Act, Title XIX, §1910 (42 U.S.C. 300w-9). The HRSA EMSC Program’s goal is to reduce pediatric morbidity and mortality related to severe illness and trauma by 1) improving the delivery and quality of EMS systems; and 2) demonstrating improved patient outcomes.

The HRSA EMSC Program is the only federal program focused specifically on improving the pediatric components of the EMS system. The Program was established

5 https://www.emscompass.org/about-ems-compass/ 6 https://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx 7 http://pedsready.org https://www.emscompass.org/about-ems-compass/ https://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx http://pedsready.org/

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by Congress in 1984 to fund demonstration projects aiming to expand and improve state emergency medical services (EMS) for children who need treatment for trauma or critical care.

Pediatric emergency care begins with the 911 call, continues through the delivery of the patient to the appropriate hospital, and ultimately concludes with the child returning to the community. The HRSA EMSC Program encourages a multifaceted approach to health care from project planning to development and implementation. Injury prevention, intervention, tertiary care, rehabilitation, and return to the community are all key parts of this multi-faceted approach.

The success of the HRSA EMSC Program requires community engagement and involvement of key stakeholders. These stakeholders include family representatives, state and local EMS agencies, hospitals, state maternal and child health programs, as well as representatives from state offices of rural health, highway safety, hospital preparedness programs, and tribal health. As such, each EMSC SP recipient is required to facilitate an EMSC Advisory Committee with eight core members:

• EMSC project director

• EMSC grant manager

• EMS state agency representative (e.g., EMS medical director, EMS administrator)

• Nurse with emergency pediatric experience

• Physician with pediatric training (e.g., pediatrician or pediatric surgeon)

• Emergency physician (a physician who primarily practices in the emergency department; does not have to be a board-certified emergency physician)

• Emergency medical technician (EMT)/Paramedic who is currently a practicing, ground level pre-hospital provider (i.e., must be currently licensed and riding in a patient care unit such as an ambulance or fire truck)

• Family representative

EMSC family representatives play a unique role in program success. These representatives sit on state EMS advisory committees and serve on the EMSC Family Advisory Network (FAN). The EMSC FAN representatives foster partnerships within their communities, and the consumers’ perspective to improve the delivery of patient care, and promote the integration of family- and patient-centered practices within health care systems.

The EMSC SP Program aims to establish a universal presence across all 59 U.S. states and jurisdictions to ensure that children receive optimal emergency care no matter where they live or travel. Each state and jurisdiction works to improve the same pre-hospital and hospital performance measures, representing the largest national effort to standardize pediatric emergency care.

Past Efforts In 2004, HRSA MCHB instituted a set of performance measures (PM) for the EMSC SP Program in response to the Government Performance and Results Act (GPRA) of 1993 (Public Law 103-62), which mandated federal programs to be accountable for achieving

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outcomes. The EMSC SP Program PMs have guided national efforts for more than 10 years to make progress toward the following outcomes:

1) nationally recommended pediatric equipment is readily available in ambulances;

2) pre-hospital providers receive pediatric-focused training regularly and frequently to ensure that they are prepared to manage pediatric medical and traumatic emergencies;

3) pre-hospital providers have access to pediatric medical direction whenever needed to ensure the right care at the right time;

4) hospitals are equipped to manage pediatric medical and traumatic emergencies;

5) health care facilities have well-defined guidelines and clearly understood processes that ensure the immediate transfer of children to the most appropriate facility when medically necessary; and

6) EMSC is integrated and institutionalized within state EMS systems.

The EMSC SP Program has systematically demonstrated improvements through the tracking of these PMs. Examples of change over time are included in the table below.

Measure 2010 2013 Change Pre-Hospital The percent of EMS agencies in the state/jurisdiction that have a pediatric protocol available

77.8% 84.5% +6.7%

The percent of EMS patient care units in the state/jurisdiction that have the essential pediatric equipment and supplies as outlined in national guidelines

24% 28% +4%

Hospital The number of hospitals recognized through a statewide, territorial, or regional standardized system that are able to stabilize and manage pediatric medical emergencies

+31

The percent of hospitals in the state/jurisdiction that have written inter-facility transfer guidelines that cover pediatric patients

43% 53% +10%

Sustainability The number of states/jurisdictions that have established permanence of EMSC in the state/jurisdiction EMS system

+29

In 2013, the HRSA EMSC Program collaborated with the American Academy of Pediatrics, the Emergency Nurses Association, the American College of Emergency Physicians, and others in a QI initiative called “The National Pediatric Readiness Project.” The QI initiative allows hospital emergency departments (EDs) to self-assess their readiness to care for children based on the recommended 2009 joint policy statement, “Guidelines for Care of Children in the Emergency Department.”10 Through a collaborative process, the national organizations and EMSC grant recipients reached

8 In 2010, five states had statewide recognition systems. In 2013, nine states had a statewide recognition system.

9 A set of six criteria are used to measure the degree to which a state has established permanence of

EMSC. In 2010, the number of states that met the criteria include one state meeting one criteria, three meeting two of the criteria, 13 meeting three of the criteria, and 17 meeting four of the criteria. No states had met five or all six of the criteria.

10 Joint Policy Statement—Guidelines for Care of Children in the Emergency Department. (2009).

American Academy of Pediatrics, Volume 124. Retrieved from http://pediatrics.aappublications.org/content/124/4/1233.

http://pediatrics.aappublications.org/content/124/4/1233

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out to EDs to encourage their participation. As a result, over 4,000 EDs across the U.S.

participated in the QI project, representing 83 percent of the nation’s EDs. The results from the initiative prompted the HRSA EMSC Program to focus on initiatives that promoted the following system-level changes:

o children are weighed in kilograms rather than pounds to prevent medical errors;

o inter-facility transfer agreements are in place to prevent any delays when there is an urgent need to transfer a child to a higher level of pediatric emergency care;

o disaster plans address issues specific to the care of children; and o EDs have a physician or nurse champion for pediatric emergency care.

The NPRP online portal, accessed at http://pedsready.org, is managed by the National EMSC Data Analysis and Resource Center (NEDARC). HRSA intends to sustain support for the portal to allow hospitals the opportunity to gauge and monitor their progress, and to support local and national QI activities.

In 2016, the HRSA EMSC Program piloted the use of a QI collaborative model to help states develop systems and or programs that would support the readiness of hospital EDs to care for children during an emergency. A cohort of 13 states and the District of Columbia are actively participating in a QI collaborative to promote pediatric readiness efforts at the state level.

Future Efforts

Previous successes have informed key focus areas of this next stage of the EMSC SP Program. These focus areas include:

- align program investments to amplify and demonstrate impact;

- develop the workforce across the continuum of emergency care to ensure capability in demonstrating impact;

- mobilize the partnership community to achieve impact; and

- promote the value and impact of the HRSA EMSC Program by communicating outcomes.

Improvements in the National EMSC Performance Measures

Data reports from EMSC SP recipients indicate that there is still a need to improve the capabilities of facilities to stabilize, manage, treat, and transport pediatric patients during emergencies. There is also an indication that the EMSC SP Program still needs to ensure that inter-facility transfer guidelines and agreements are in place and that pediatric needs are uniquely addressed within state pre-hospital and hospital systems.

Together, the new and continuing PMs aim to highlight the EMSC SP Program’s policy and practice improvements at the state and national level. The PMs are available in the EMSC Performance Measures Manual at http://nedarc.org/performanceMeasures/documents/EMS%20Perf%20Measures%20Ma nual%20Web_0217.pdf.

http://pedsready.org/

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HRSA will work with EMSC stakeholders to develop relevant metrics to describe progress in pediatric health outcomes, which may be incorporated to supplement and/or revise program performance measures identified in this NOFO during the grant period.

Quality Improvement Collaboratives

Additional EMSC QI collaboratives will be launched to support recipients, and the NPRP Assessment will be launched in future years. Recipients will be required to participate in at least one QI collaborative aimed to improve health outcomes. In partnership with HRSA, the EMSC Innovation and Improvement Center, and NEDARC, the health outcome priorities will be determined in collaboration with the states and national health care priorities such as behavioral health and the opioid crisis.

National Pediatric Readiness Project

Recipients will be expected to continue promoting the National Pediatric Readiness Project (NPRP) as an ongoing quality improvement tool to help hospitals improve care for children.

II. Award Information

1. Type of Application and Award

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

HRSA will provide funding in the form of a grant.

2. Summary of Funding

Approximately $7,670,000 is expected to be available annually to fund 59 recipients.

You may apply for a ceiling amount of up to $130,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The actual amount available will not be determined until enactment of the final FY 2018 federal appropriation. The FY 2018 President’s Budget does not request funding for this program. 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 April 1, 2018 through March 31, 2022 (4 years). Funding beyond the first year is dependent on the availability of appropriated funds for the EMSC SP 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.

Limitations on indirect cost rates: This program does NOT support research activities, therefore, you may not use research indirect cost rates. The "Other Sponsored 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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Program/Activities" rate should be applied. If you are without an established indirect cost rate for “other sponsored programs” may only request 10 percent of salaries and wages, and must request an “other sponsored programs” rate from HHS’s Cost Allocation Services (CAS). Visit CAS’s website at https://rates.psc.gov/ to learn more about rate agreements, the process for applying for them, and the regional offices which negotiate them.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include state governments and accredited schools of medicine in states and jurisdictions. Under the authorizing statute for HRSA-supported EMSC programs, only three EMSC grant awards per state or jurisdiction may be awarded to a state or jurisdiction during any fiscal year subject to this limitation

The term “school of medicine” for the purpose of this funding opportunity (and under 42 U.S.C. 300w-9(c)) has the same meaning as set forth in section 799B(1)(A) of the Public Health Service Act (42 U.S.C. 295p(1)(A)), i.e.:.

an accredited public or nonprofit private school in a state that provides training leading … to a degree of doctor of medicine.

The term “accredited” in this context has the same meaning as set forth in section 799B(1)(E) of the Public Health Service Act (42 U.S.C. 295p(1)(E)), which, when applied to a school of medicine, means a school or program that is accredited by a recognized body or bodies approved for such purpose by the Secretary of Education, except that a new school or program that, by reason of an insufficient period of operation, is not, at the time of application for a grant or contract under this subchapter, eligible for accreditation by such a recognized body or bodies, shall be deemed accredited for purposes of this subchapter, if the Secretary of Education finds, after consultation with appropriate accreditation body or bodies that there is reasonable assurance that the school or program will meet the accreditation standards of such body or bodies prior to the beginning of the academic year following the normal graduation date of the first entering class in such school or program.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

https://rates.psc.gov/

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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.

Letters of Support must be included (Attachment 7) from key stakeholders, including the EMSC family representative(s), state EMS agency (if not the main applicant), local EMS agencies, hospitals, and state maternal and child health programs. Additional stakeholders include representatives from state offices of rural health, highway safety, hospital preparedness programs, Indian health, and others responsible for the continuum of care for children in each state. If the main applicant is not the State Office of EMS, a letter of support must be included from the State Office of EMS. Letters must be current and dated. If Letters of Support cannot be obtained, the reasons for this, along with documentation showing timely and reasonable attempts to obtain them, must be documented in the application. Failure to attach Letters of Support or the documentation described above will result in the application being considered non-responsive and not considered for funding under this announcement.

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 application workspace package. After this date, you will no longer be able to use PDF Application Packages.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing the notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html

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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)).

See Section 8.5 of the SF-424 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 including biographical sketches (bio sketches), and letters of commitment and support required in HRSA’s SF-424 Application Guide and this NOFO. Standard OMB-approved forms that are included in the application package do not count in the page limitation. Biographical sketches do count in the page limitation. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) will not be counted in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included. Include as part of Attachment 7- 15, Other Relevant Documents.

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

http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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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), 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.

Applications must contain the information below. Please use the section headers for the Project Narrative in the following order:

I. Introduction II. Needs Assessment III. Methodology IV. Work Plan V. Resolution of Challenges VI. Evaluation and Technical Support Capacity VII. Organizational Information

Specific details to include related to each section are as follows:

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

Briefly describe the state’s health care system and purpose of the proposed project. Key information may include: number of hospitals, including critical access hospitals, and EMS agencies in the state; number of EMS patient transports per year and of those how many are pediatric patients (up to 18 years of age); the five most common types of severe injury and acute illnesses within the state’s pediatric population; number of ED visits and of those visits, how many are pediatric patients; and any other information that may help describe the state’s health care system and the prevalence of pediatric illness and injury in the state. If this information is not known at this time, include details that are available to help describe the health care system in the state.

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NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion 1 (Need)

Describe the health care needs of the state as they relate to the EMSC SP Performance Measures. Provide a descriptive analysis to show the degree of change over time across each performance measure, and which performance measures are most likely to improve the health care for the pediatric population in the state or jurisdiction.

METHODOLOGY -- Corresponds to Section V’s Review Criteria 2, 3 and 4 (Response, Evaluative Measures, Impact)

This section outlines the proposed methods used to address the aforementioned needs and how you intend to meet each of the previously described objectives in this NOFO. You must develop specific, measurable, achievable, relevant, and time-related (SMART) objectives that directly contribute to achieving the seven program objectives and six program activities listed in the Purpose section of this funding notice included on pages 1 to 3.

You must clearly describe the activities in the form of detailed action steps.

Methods proposed must be clear and concise, include monitoring and evaluation to measure progress and results, and describe how project results will be disseminated.

Proposed activities must demonstrate the active engagement of a FAN representative in project development and implementation. Some examples of FAN activities include: outreach and education; participating in planning, implementation, and evaluation of program activities at all levels; strategic planning; materials development; and other activities aimed to achieve a specific EMSC PM standard.

WORK PLAN -- Corresponds to Section V’s Review Criteria 2, 3 and 4 (Response, Evaluative Measures and Impact)

Use a timeline that includes each activity and identifies responsible staff. As appropriate, describe meaningful support and collaboration with the EMSC Advisory Committee, FAN representative(s), and other key stakeholders. This may include support and collaboration in planning, designing, and implementing activities, including development of the application. The active engagement of FAN representatives in state and national activities demonstrates an important connection with the community and the families served by the EMSC SP Program.

Ensure that the activities align with the objectives listed in the purpose and methodology section of this NOFO.

Note: the timeline (referenced above) must include all 4 years of the anticipated project period, and must be uploaded with the application as part of Attachment 1.

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

You must discuss anticipated challenges in designing and implementing the activities described in the work plan, and the approaches that will be used to resolve such challenges.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criteria 3, 4, 5 (Evaluative Measures, Impact and Resources/Capabilities

This section of the project narrative serves to illustrate a plan to evaluate current status, monitor progress, demonstrate impact, and ensure resources and support are available to manage, implement, and sustain the project beyond federal funding. You must include evaluation plans that demonstrate how outcomes can be attributed to the project.

This section must include a carefully designed evaluation plan capable of demonstrating and documenting measurable progress toward reaching the seven stated objectives found in the Purpose section, as well as the SMART objectives included in the state/jurisdiction’s proposal. The evaluation plan must include strategies for collection, analysis, and evaluation of the EMSC performance measures and the NPRP Project objectives.

Details in this section should also describe the technical support capacity of the staff supporting the project. Include the current experience, skills, and knowledge of EMSC SP staff. Include materials published and previous work with the key stakeholders.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion 5 (Resources/Capabilities)

You must succinctly describe the organization’s current mission, scope of current activities, and provide an organizational chart.11 Describe how these elements all contribute to the organization’s ability to meet the program requirements and expectations. Describe how key stakeholders, including the EMSC Advisory Committee, contribute to the ability of the organization to meet program requirements and expectations. The names of the EMSC SP project director, EMSC SP program manager, and the FAN representative must be included in this section. Also include brief descriptions of roles and responsibilities for these individuals. Describe the percent of time dedicated to the project by the EMSC SP program manager and project director. Indicate if the time dedicated is supported by federal or non-federal funds, or both. Provide each individual’s name and background. The staffing plan and job descriptions for the program manager, project director and any other key faculty/staff must be included in Attachment 2

11 A one-page figure that depicts the organizational structure of the project, including subcontractors and other significant key stakeholders.

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(Staffing Plan and Job Descriptions). The organizational chart must be included in Attachment 3. As a key role for the EMSC SP Program, the FAN representative must also be included in the organizational chart, regardless of paid or unpaid status.

Discuss how the organization will follow the approved plan, as outlined in the application; properly account for the federal funds; and document all costs so as to avoid audit findings.

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, (3) Evaluative Measures, and (4) Impact

Work Plan (2) Response, (3) Evaluative Measures, and

(4) Impact

Resolution of Challenges (2) Response Evaluation and Technical Support Capacity

(3) Evaluative Measures, (4) Impact, and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget and Budget Narrative (below)

(6) Support Requested – the budget section 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 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.

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.

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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.” 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.

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

The budget narrative should clearly describe how each item supports the proposed objectives.

The project period is from April 1, 2018 to March 31, 2022. The award will be for 4 years and may be extended for an optional 5th year, subject to an annual evaluation by the Secretary.

Each budget period is for 12 months. The 12-month budget periods and corresponding fiscal years are as follows:

Year 1 April 1, 2018 to March 31, 2019 Fiscal Year 2018 Year 2 April 1, 2019 to March 31, 2020 Fiscal Year 2019 Year 3 April 1, 2020 to March 31, 2021 Fiscal Year 2020 Year 4 April 1, 2021 to March 31, 2022 Fiscal Year 2021

In addition, the EMSC SP Program requires the following:

You must submit four 12-month budgets, each totaling up to $130,000 per year for year 1 to 4 at the time of application. The budget narrative and activities proposed must be consistent with the objectives, methods, and activities in the Purpose section of this NOFO. You are required to focus activities toward the achievement of the EMSC Performance Measures.

You are encouraged to show that the proposed activities and associated costs clearly demonstrate the active engagement of a FAN representative in project development and implementation. Related activities and cost associated with activities that engage a FAN representative may be included. A FAN representative must be named and a description of the person’s background must be provided in the Project Narrative and Organizational Information sections.

Subject to the Program review and approval: Program PMs are priorities for the EMSC SP Program. Additional activities may be proposed, provided efforts and sufficient resources have been directed to activities that directly support the advancement of the EMSC PMs. Additional activities proposed must clearly explain how the activity will contribute to advancing the EMSC Program’s mandate - to expand and improve emergency medical services for children and youth who need treatment for trauma or critical care by improving the quality and delivery of EMS http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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systems; with the ultimate goal of demonstrating an impact to reducing pediatric morbidity and mortality related to medical or traumatic emergencies. Funds of up to 10 percent may be allocated for other project activities. You must ensure that the proposed activity is clearly explained in the project narrative within the required sections (Introduction, Needs Assessment, Methodology, Work Plan, Resolution of Challenges, Evaluation and Technical Support Capacity).

Note: Pediatric Education, Disaster Preparedness, Pediatric Emergency Department Readiness, and Pediatric Regionalization activities directly relate to EMSC SP Program objectives and activities included in this funding notice. These types activities are not considered “Additional Activities.”

Include a Budget Spreadsheet and Narrative organized by the following budget categories: Personnel Costs, Fringe Benefits, Travel, Equipment, Supplies, Contractual, Other, and Indirect Costs.

Personnel Costs: Personnel costs should be explained by listing each staff member who will be supported with funds. Include the individual’s name (if possible), position title, percentage of full-time equivalency, and annual salary. Reminder: Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II or $187,000.

You must budget for a full-time program manager to oversee the EMSC SP Program. EMSC federal funds do not need to be the primary source of funding for a program manager position. However, a full-time (40 hours per week) program manager must be designated/assigned to the EMSC SP Program. Include the full salary of the program manager position, the name of the program manager, the percent of time and salary that will be paid by EMSC federal funds, as well as the percent of time and salary that will be paid by other sources to support a 100 percent full-time equivalent program manager. Include all funding sources and a detailed scope of work for the program manager. If a program manager position is dependent upon successful grant award of the EMSC SP Program, include a plan for hire, proposed budget for the position (pro-rated), and the job description. Ensuring the engagement of a FAN representative is a requirement of the EMSC SP Program.

Hence, you may budget for a part-time FAN representative to assure that patient-centered and culturally sensitive considerations in the delivery of care remain central in planning, development, and implementation of EMSC projects.

Fringe Benefits: List the components that comprise the fringe benefit rate, for example health insurance, taxes, unemployment insurance, life insurance, retirement plans, and tuition reimbursement. The fringe benefits should be directly proportional to that portion of personnel costs that are allocated for the project. If an individual’s base salary exceeds the legislative salary cap (i.e., $187,000), adjust fringe accordingly.

Travel: Funds may be used for travel to meetings, workshops, or other activities that would support efforts to improve the quality of pediatric EMS care in your state. List costs by local and out-of-state travel. For local travel, the mileage rate, number of

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miles, reason/purpose for travel, and staff member/advisory member/FAN representative completing the travel should be outlined. For out-of-state travel, the budget should reflect the travel expenses (such as airfare, per diem, transportation, etc.), the role of the individual(s) traveling, the reason/purpose of attending, and the expected impact as a result of attending.

The recipient is required to attend program-sponsored meetings and at least one Technical Assistance Workshop. The specific meetings and workshops are as follows:

• Program-sponsored meetings. EMSC SP Program grant award recipients are required to attend HRSA-sponsored EMSC meetings each year, as indicated by the HRSA EMSC Program. HRSA may designate either an all-EMSC grantee meeting or a Program Manager’s meeting to meet this requirement each budget period.

o The all-EMSC grantee meeting will be held every other year during the 2019 and 2021 EMSC fiscal years. You must budget for at least three program representatives (the project director or EMSC medical director, program manager, and FAN representative) to attend this meeting.