oppHRSA-18-091-cfda93.870-cidHRSA-18-091-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Home Visiting and Early Childhood Systems

Maternal, Infant, and Early Childhood Home Visiting Program - Formula

Funding Opportunity Number: HRSA-18-091 Funding Opportunity Type: New

Catalog of Federal Domestic Assistance (CFDA) Number: 93.870

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: June 29, 2018

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

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: April 27, 2018

Marilyn Stephenson Supervisory Public Health Analyst Division of Home Visiting and Early Childhood Systems Maternal and Child Health Bureau Health Resources and Services Administration 61 Forsyth Street SW, Suite 3M60 Atlanta, GA 30303 Telephone: (404) 562-1489 Email: mstephenson@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Social Security Act, Title V, § 511(c) (42 U.S.C. § 711(c)), as amended by the Bipartisan Budget Act of 2018 (P.L.115-123), Title VI, Subtitle A.

mailto:mstephenson@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) is accepting applications for the fiscal year (FY) 2018 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. The purpose of this program is to support the delivery of coordinated and comprehensive high-quality voluntary early childhood home visiting services to eligible families. This program is administered by HRSA in partnership with the Administration for Children and Families (ACF).

Funding Opportunity Title: Maternal, Infant, and Early Childhood

Home Visiting Program - Formula Funding Opportunity Number: HRSA-18-091 Due Date for Applications: June 29, 2018 Anticipated Total Annual Available FY 2018 Funding:

Up to $362,200,000

Estimated Number and Type of Awards: Up to 56 grants Estimated Award Amount: Amounts vary Cost Sharing/Match Required: No Period of Performance: September 30, 2018 through

September 30, 2020 (Up to 2 years)

Eligible Applicants: Eligible recipients include the following entities currently funded in FY 2017 under the MIECHV Program: 47 states; 3 nonprofit organizations serving Florida, North Dakota, and Wyoming; and 6 territories and jurisdictions serving the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa.

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

Application Guide

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

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

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Technical Assistance

HRSA has scheduled the following technical assistance webinar:

Day and Date: Wednesday, May 9, 2018 Time: 3 - 5 p.m. ET Call-in number and registration for this webinar will be available here:

https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources

HRSA will record the webinar and archive the recording on the same webpage by Wednesday, May 16, 2018.

https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources

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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

APPENDIX A: EXPECTATIONS FOR RESEARCH AND EVALUATION ACTIVITIES

APPENDIX B: SPECIFIC GUIDANCE REGARDING PERFORMANCE INDICATORS AND

SYSTEMS OUTCOME MEASURES AND CONTINUOUS QUALITY IMPROVEMENT PLAN 53

APPENDIX C: SUPPLEMENT TO UPDATE THE STATEWIDE NEEDS ASSESSMENT

APPENDIX D: GLOSSARY OF SELECTED TERMS

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program – Formula grant. The purpose of this program is to support the delivery of coordinated and comprehensive high-quality, and voluntary early childhood home visiting services to eligible families. HRSA administers this program in partnership with the Administration for Children and Families (ACF).

Program Goals The goals1 of the MIECHV Program are to: (1) strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2) improve coordination of services for at-risk communities; and (3) identify and provide comprehensive services to improve outcomes for eligible families2 who reside in at-risk communities.

Successful MIECHV Program recipients will:

1) Implement evidence-based home visiting models or promising approaches that:

a) Include voluntary home visiting3 as the primary service delivery strategy (See Appendix D for definitions of evidence-based home visiting model and promising approach home visiting models for purposes of this NOFO.);

b) Serve eligible families residing in at-risk communities, as identified in the current statewide needs assessment;4 and

c) Target outcomes specified as legislatively mandated benchmark areas, which include: improved maternal and newborn health; prevention of child injuries, child abuse, neglect or maltreatment, and reduction of emergency department visits;

improvement in school readiness and achievement; reduction in crime or domestic violence; improvements in family economic self-sufficiency; and improvements in the coordination and referrals for other community resources and supports.5

2) Ensure the provision of high-quality home visiting services to eligible families living in at-risk communities by, in part, coordinating with comprehensive statewide early childhood systems to support the needs of those families.

The authorizing legislation reserves the majority of funding for the delivery of services through implementation of one or more evidence-based home visiting service delivery

1 Social Security Act, Title V, § 511(a).

2 Under Social Security Act, Title V, § 511(k)(2), “[t]he term “eligible family” means— (A) a woman who is pregnant, and the father of the child if the father is available; or (B) a parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, who are serving as the child’s primary caregiver from birth to kindergarten entry, and including a noncustodial parent who has an ongoing relationship with, and at times provides physical care for, the child.”

3 Social Security Act, Title V, § 511(e)(7)(A).

4 Social Security Act, Title V, § 511(b).

5 Social Security Act, Title V, § 511(d)(1)(A).

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models.6 Home visiting service delivery models meeting U.S. Department of Health and Human Services (HHS)-established criteria for evidence of effectiveness and eligible for implementation under MIECHV have been identified.7 Per statute, recipients may expend no more than 25 percent of the grant(s) awarded for a fiscal year for conducting and evaluating a program using a service delivery model that qualifies as a promising approach.8

2. Background

Statutory Authority This program is authorized by Social Security Act, Title V, § 511(c) (42 U.S.C. § 711(c)), as amended by the Bipartisan Budget Act of 2018 (P.L. 115-123).

The MIECHV Program responds to the diverse needs of children and families in at-risk communities. At-risk communities are identified in a statewide needs assessment9 as those communities for which indicators, in comparison to statewide indicators, demonstrated that the community is at greater risk than the state as a whole. At-risk communities are further defined as communities with concentrations of the following indicators: premature birth, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health; poverty; crime; domestic violence; high rates of high-school drop-outs;

substance abuse; unemployment; or child maltreatment.10

The MIECHV Program provides an opportunity for increased collaboration and partnership at the federal, state, tribal, and community levels to improve health and developmental outcomes for children through evidence-based home visiting programs.

The funds are intended to assure effective coordination and delivery of critical health, developmental, early learning, child abuse and neglect prevention, and family support services to these children and families who choose to participate in home visiting programs.

This program plays a crucial role in building high-quality, comprehensive statewide early childhood systems to support pregnant women, parents and caregivers, and children from birth to kindergarten entry, and ultimately to improve health and development outcomes. An early childhood system aims to: reach all children and families as early as possible with needed services and supports; reflect and respect the strengths, needs, values, languages, cultures, and communities of children and families; ensure stability and continuity of services along a continuum from pregnancy to kindergarten entry;

effectively include and accommodate children with special needs and their families;

support continuity of services, eliminate duplicative services, ease transitions, and improve the overall service experience for families and children; value parents and

6 Social Security Act, Title V, § 511(d)(3)(A) identifies various specific criteria applicable to such evidence-based home visiting models.

7 See Section VIII for a list of evidence-based home visiting models eligible for implementation under MIECHV that meet the HHS-established criteria for evidence of effectiveness.

8 Social Security Act, Title V, § 511(d)(3)(A). See Appendix D for a definition of promising approach.

9 Social Security Act, Title V, § 511(b)(1)(A).

10 Social Security Act, Title V, § 511(b)(1)(A).

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community members as decision makers and leaders; and catalyze and maximize investment and foster innovation.

Recipients partner with behavioral health agencies, local service providers, and other stakeholders to refer to and coordinate with necessary services to address issues related to mental health and substance use, including opioid use and neonatal abstinence syndrome. These services include maternal depression screenings and referrals, and mental health consultation to increase the capacity of home visitors to support families impacted by mental health and substance use challenges. To address intimate partner violence (IPV), home visitors screen families for IPV, educate caregivers about the effects of IPV on parents and their young children, and refer families to domestic violence programs for counseling and other services. Toward reduced incidence of childhood obesity, home visitors evaluate families’ needs and provide services tailored to those needs that include: parent education on the benefits of breastfeeding, healthy physical activity of children and the importance of well-child visits; and initiating referral partnerships with child nutrition programs such as the state’s Special Supplemental Nutrition Program for Women, Infants, and Children.

Additionally, MIECHV recipients are required to collect performance measurement data on the percentage of infants who are breastfed, the number of enrolled primary caregivers screened for depression, and the number of completed referrals for depression services. Through a statewide needs assessment, authorizing legislation also required recipients to identify the state’s, territory’s, or jurisdiction’s capacity for providing substance use disorder treatment and counseling services to individuals and families in need of such treatment or services, among other requirements. An update to this statewide needs assessment is required by October 1, 2020.11

Current Funding In FY 2018, up to $362.2 million is available for awards to the 56 eligible entities that currently receive MIECHV formula funding to deliver such services to states, territories, and jurisdictions (see Eligibility Information). This includes up to $351.0 million in formula awards to support the delivery of home visiting services, as well as up to $11.2 million for eligible entities to update their statewide needs assessments by the statutory deadline of October 1, 2020.12

Section II describes the formula applied to FY 2018 funding available to provide services to states, territories, and jurisdictions. In addition to the FY 2018 formula award, each eligible applicant’s award ceiling will include a one-time supplement of $200,000 to support an update to the statewide needs assessment. Any remaining requested supplement funds not allocated towards completing a needs assessment update must be budgeted for continuous quality improvement (CQI) activities as outlined in a HRSA-approved CQI Plan. (See Appendix C for more information.)

11 Social Security Act, Title V, § 511(b)(1), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50603.

12 Social Security Act, Title V, § 511(b)(1), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50603.

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Program Activities and Expectations

Priority for Serving High-Risk Populations As required by statute,13 recipients must give priority in providing services under the MIECHV Program to the following:

• Eligible families who reside in communities in need of such services, as identified in the statewide needs assessment required under subsection 511(b)(1)(A), taking into account the staffing, community resource, and other requirements to operate at least one approved model of home visiting and demonstrate improvements for eligible families;

• Low-income eligible families;

• Eligible families with pregnant women who have not attained age 21;

• Eligible families that have a history of child abuse or neglect or have had interactions with child welfare services;

• Eligible families that have a history of substance abuse or need substance abuse treatment;

• Eligible families that have users of tobacco products in the home;

• Eligible families that are or have children with low student achievement;

• Eligible families with children with developmental delays or disabilities; and

• Eligible families that include individuals who are serving or formerly served in the

Armed Forces, including such families that have members of the Armed Forces who have had multiple deployments outside of the United States.

Selection of a Home Visiting Service Delivery Model As noted above, the majority of program funding is reserved for the delivery of services through implementation of one or more evidence-based home visiting service delivery models.14 Recipients may expend no more than 25 percent of the grant(s) awarded for a fiscal year for conducting and evaluating a program using a service delivery model that qualifies as a promising approach.15 Home visiting service delivery models meeting HHS-established criteria for evidence of effectiveness have been identified. (See Section VIII for a list of evidence-based models eligible for implementation under MIECHV that meet the HHS criteria for evidence of effectiveness.)

When selecting a model or multiple models, recipients should ensure the selection can:

1) meet the needs of the state’s, territory’s, or jurisdiction’s identified at-risk communities and/or the state’s, territory’s, or jurisdiction’s targeted priority populations named in statute;16

2) provide the best opportunity to accurately measure and achieve meaningful outcomes in benchmark areas and measures;

3) be implemented effectively with fidelity to the model in the state, territory, or jurisdiction based on available resources and support from the model developer;

and

13 Social Security Act, Title V, §511(d)(4), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50604, indicates the priority for serving high-risk populations.

14 Social Security Act, Title V, § 511(d)(3)(A) identifies various specific criteria applicable to such evidence-based service delivery models.

15 See Appendix D for a definition of promising approach (Social Security Act, Title V, § 511(d)(3)(A)).

16 Social Security Act, Title V, §511(d)(4), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50604, indicates the priority for serving high-risk populations.

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4) be well matched for the needs of the state’s, territory’s, or jurisdiction’s early childhood system.

Recipients may select multiple models for different communities and use a combination of models with a family, while avoiding concurrent dual enrollment and impairment of fidelity to the models used, to support a continuum of home visiting services that meets families’ specific needs.

Fidelity to a Home Visiting Service Delivery Model Recipients must ensure fidelity of implementation of evidence-based home visiting service delivery models approved for use under this NOFO and that meet the HHS criteria for evidence of effectiveness.17 (See Section VIII for a list of evidence-based models eligible for implementation under MIECHV that meet the HHS-established criteria for evidence of effectiveness.) Additionally, any recipient implementing a home visiting service delivery model that qualifies as a promising approach must also implement the model with fidelity. Fidelity is defined as a recipient’s adherence to model developer requirements for high-quality implementation as well as any applicable affiliation, certification, or accreditation required by the model developer, if applicable.

These requirements include all aspects of initiating and implementing a home visiting model, including, but not limited to:

• Recruiting and retaining clients;

• Providing initial and ongoing training, supervision, and professional development for staff;

• Establishing a management information system to track data related to fidelity and services; and

• Developing an integrated resource and referral network to support client needs.

Changes to an evidence-based model that alter the core components related to program outcomes are not permissible, as they could impair fidelity and undermine the program’s effectiveness.

Model Enhancements For the purposes of the MIECHV Program, an acceptable enhancement of an evidence-based model is a variation to better meet the needs of targeted at-risk communities that does not alter the core components of the model. Model enhancements may or may not have been tested with rigorous impact research. Recipients who wish to adopt enhancements must submit written prior approval from the national model developer(s) and from HRSA. Prior to implementation, the model developer must determine that the enhancement does not alter the core components related to program impacts, and HRSA must determine it to be aligned with MIECHV Program activities and expectations.

All model enhancements proposed for FY 2018 must be provided per instructions in Section IV .

17 Social Security Act, Title V, § 511(d)(3)(A)(iii).

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Enrollment Recipients must implement home visiting programs with fidelity to the model, which may include development of policies and procedures to recruit, enroll, disengage, and re-enroll home visiting services participants. Enrollment policies should strive to balance continuity of services to eligible families and availability of slots to unserved families.

Dual enrollment refers to home visiting participant enrollment and receipt of services through more than one MIECHV-supported home visiting model concurrently. Toward responsible fiscal stewardship and to maintain model fidelity, recipients should develop and implement policies and procedures to avoid dual enrollment. Recipients implementing more than one MIECHV-supported home visiting model, particularly in the same at-risk community, should, with fidelity to the model, develop policies and procedures to screen and enroll eligible families in the model that best meets their needs. Avoiding dual enrollment maximizes the availability of limited resources for home visiting services for eligible families and prevents duplicative collection and reporting of benchmark data.

Collaboration with Early Childhood Partners and Early Childhood System Coordination Per the authorizing legislation, recipients will ensure the provision of high-quality home visiting services to eligible families in at-risk communities by, in part, coordinating with comprehensive statewide early childhood systems to support the needs of those families.18 To do this, recipients must establish appropriate linkages and referral networks to other community resources and supports, including those represented in comprehensive statewide and local early childhood systems.19 An early childhood system brings together health, early care and education, and family support program partners, as well as community leaders, families, and other stakeholders to achieve agreed-upon goals for thriving children and families. (See Appendix D for a definition of early childhood system.)

Consistent with model fidelity requirements, recipients must develop and implement, in collaboration with other federal, state, territory, tribal, and local partners, a continuum of home visiting services to support eligible families and children prenatally through kindergarten entry. To this end, recipients should develop policies and procedures in collaboration with other home visiting and early childhood partners to transition families into other home visiting or early childhood services to sustain services to eligible families of children through kindergarten entry.

Recipients must ensure involvement in the MIECHV project planning, implementation, and/or evaluation by at least one of the recipient’s statewide early childhood systems entities (e.g., Early Childhood Comprehensive Systems recipient, Early Childhood Advisory Council, Governor’s Children’s Cabinet, Individuals with Disabilities Education Act (IDEA) Part C Interagency Coordinating Council, etc.). Additionally, recipients must ensure involvement in the MIECHV project planning, implementation, and/or evaluation by representatives of the agencies listed below through development of memoranda of understanding or letters of agreement with:

18 Social Security Act, Title V, § 511(b)(1)(B).

19 Social Security Act, Title V, § 511(d)(3)(B).

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• The state’s Early Childhood Comprehensive Systems (ECCS) recipient if there is one;

• The state’s Maternal and Child Health Services (Title V) agency;

• The state’s Public Health agency, if this agency is not also administering the state’s Title V program;

• The state’s agency for Title II of the Child Abuse Prevention and Treatment Act

(CAPTA);

• The state’s child welfare agency (Title IV-E and IV-B), if this agency is not also administering Title II of CAPTA;

• The state’s Individuals with Disabilities Education Act (IDEA) Part C and Part B

Section 619 lead agency(ies); and

• The state’s Elementary and Secondary Education Act Title I or state pre-kindergarten program.

The memoranda of understanding or letters of agreement should be current, dated, and address referrals, screening, follow-up and service coordination as well as systems and data coordination as applicable to each partner’s scope. (NOTE: Previously approved memoranda of understanding or letters of agreement that are not time-limited to a date prior to the date of application will satisfy this requirement and do not need to be re-submitted. New or updated memoranda of understanding and letters of agreement with the partners listed above will be due to HRSA within 180 days of grant award. Memoranda of understanding and letters of agreement are not required to be legally binding.)

MIECHV recipients should invite representatives of ECCS funding recipients and a tribal representative, if serving any at-risk communities with high concentrations of American Indian and Alaska Native (AIAN), to serve on the MIECHV recipient advisory group (also known as State Team, Advisory Council, etc.), whenever feasible.

Through project planning and service coordination at state, territory and/or local levels, recipients should ensure that home visiting is part of a continuum of early childhood services. (See Appendix D for a definition of early childhood system and a list of potential system partners.)

High Quality Supervision Recipients must maintain high quality supervision20 to establish home visitor competencies. A successful recipient could demonstrate high quality supervision by ensuring the provision of reflective supervision to home visitors funded through the MIECHV grant. (See Appendix D for a definition of reflective supervision.) Recipients and local implementing agencies should develop and implement policies and procedures that assure the effective provision of reflective supervision program-wide with fidelity to the model(s) implemented.

State-Led Evaluation – Promising Approaches Per statute, recipients may expend no more than 25 percent of the grant(s) awarded for a fiscal year for conducting and evaluating a program using a service delivery model

20 Social Security Act, Title V, § 511(d)(3)(B)(iii).

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that qualifies as a promising approach.21 Recipients that propose to implement a home visiting model that qualifies as a promising approach are required to conduct a rigorous evaluation of that approach.22 The purpose of such an evaluation is to contribute to the evidence that may help support meeting HHS’ criteria of effectiveness for the promising approach. Such an evaluation must include an appropriate evaluation design for an assessment of impact using an appropriate comparison condition and meet expectations of rigor outlined in Appendix A. (See also Appendix D for a definition of promising approach.) Recipients may propose to continue an existing evaluation of a promising approach implemented through prior MIECHV awards in order to meet the requirements of this section. An evaluation plan describing the technical details of the evaluation is due to HRSA no later than 120 days after issuance of the Notice of Award.

Further guidance and technical assistance will be available after HRSA issues the award.

State-Led Evaluation – Evaluations of Other Recipient Activities Recipients that do not propose to implement a home visiting model that qualifies as a promising approach are not required to conduct an evaluation of their home visiting program. However, HRSA encourages recipients to conduct and/or continue evaluations, particularly if implementing an approved model enhancement. The purpose of such an evaluation is to contribute to the recipients’ own understanding of their program and improve program design and/or operations based on empirical information. Recipients that propose to conduct or continue an evaluation must ensure the evaluation answers an important question of interest to the recipient, includes an appropriate evaluation design, and meets expectations of rigor outlined in Appendix A.

Recipients proposing to continue an existing evaluation should review additional guidance outlined in Appendix A. An evaluation plan describing the technical details of the evaluation is due to HRSA no later than 120 days after issuance of the Notice of Award. Further guidance and technical assistance will be available after HRSA issues the award.

Subrecipient Monitoring Recipients must monitor subrecipient performance for compliance with federal requirements and performance expectations, including timely Federal Funding Accountability and Transparency Act (FFATA) reporting. (For additional information regarding Subrecipient Monitoring and Management, see 45 CFR § 75.351. For additional information about FFATA reporting, see Section IV.)

Recipients must effectively manage all subrecipients of MIECHV funding to ensure successful performance of the MIECHV Program. Recipients must also execute subrecipient agreements that incorporate all of the elements of 45 CFR 75.352 and, either expressly or by reference, the subrecipient monitoring plan developed by the recipient.

Monitoring activities must ensure subrecipients comply with applicable requirements outlined in the Uniform Administrative Requirements, Cost Principles and Audit

21 Social Security Act, Title V, § 511(d)(3)(A). See Appendix D for a definition of promising approach.

22 Social Security Act, Title V, § 511(d)(3)(A)(i)(II).

http://www.ecfr.gov/cgi-bin/text-idx?SID=02e77239eb166b85d522ee4868df00f4&mc=true&node=sg45.1.75_1344_675_1350.sg4&rgn=div7

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Requirements at 45 CFR part 75 and authorizing legislation.23 Effective monitoring of MIECHV subrecipients by recipients includes on-site reviews, audits, and other forms of program monitoring and oversight that optimize enrollment and retention of eligible families in home visiting services in at-risk communities, and ensure implementation of home visiting models with fidelity and proper expenditure of funds.

Recipients must develop a subrecipient monitoring plan that includes evaluation of each subrecipient's risk of noncompliance or non-performance, identifies the person(s) responsible for each monitoring activity, and includes timelines for completion for each monitoring activity. Subrecipient monitoring activities should be designed to ensure that the subaward:

• Is used for authorized purposes;

• Is used for allowable, allocable, and reasonable costs;

• Is in compliance with federal statutes and regulations;

• Is in compliance with the terms and conditions of the subaward; and

• Achieves applicable performance goals.

Subrecipient monitoring plans must also include provision for:

• Review of financial and performance reports as required by the recipient in compliance with federal requirements;

• Follow-up procedures to ensure timely and appropriate action by the subrecipient on all deficiencies identified through required audits, site visits, or other procedures pertaining to the federal award; and

• Issuance of a management decision for audit findings (as applicable) pertaining to the federal award provided to the subrecipient as required by 45 CFR §75.521.

Continuous Quality Improvement Plan Recipients are required to implement an approved Continuous Quality Improvement (CQI) Plan that meet the requirements outlined in Appendix B. A new or updated CQI plan will be required in early FY 2019. If a new or updated plan is requested by HRSA or the recipients, the amended plan must be approved by HRSA. No plan is required for submission with this application.

Performance Measurement Plan Recipients are required to continue to implement a Performance Measurement Plan approved by HRSA. If a revision is requested by HRSA or the recipient, the amended plan must be approved by HRSA. (See Appendix B for more information about performance measurement.). A proposed plan is not required to be submitted with this application.

Limit of Funds to Support Direct Medical, Dental, Mental Health, or Legal Services Funds made available to recipients under this NOFO must be used to support the delivery of home visiting services under the MIECHV Program. Grant funds may not be used except as provided for in the authorizing legislation and applicable implementing program policy issuances, including this NOFO and the Notice(s) of Award, as well as other federal laws, regulations, and policies applicable to the use of federal grant awards.

23 Social Security Act, Title V, § 511(d).

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75&rgn=div5#se45.1.75_1512

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The MIECHV Program generally does not fund the delivery or costs of direct medical, dental, mental health, or legal services; however, some limited direct services may be provided (typically by the home visitor) to the extent required in fidelity to an evidence-based model approved for use under MIECHV. Recipients may coordinate with and refer eligible families to direct medical, dental, mental health or legal services and providers covered by other sources of funding, for which non-MIECHV sources of funding may provide reimbursement.

Limit on Use of Funds for Recipient-Level Infrastructure Expenditures Absent prior approval from HRSA, no more than 25 percent of the award amount may be spent on a combination of administrative expenditures (further subject to a 10 percent cap,24 see Section IV) and infrastructure expenditures necessary to enable recipients to deliver MIECHV services.

For purposes of this NOFO, the term “infrastructure expenditures” refers to recipient-level expenditures necessary to enable recipients to deliver MIECHV services, but does not include the costs of delivering such home visiting services. It includes administrative costs related to programmatic activities, indirect costs, and other items, but does not include “administrative expenditures,” and therefore is not subject to the 10 percent limit on administrative expenditures. (See Section IV.)

Recipient-level infrastructure expenditures necessary to enable delivery of MIECHV services subject to the 25 percent limit include recipient-level personnel, contracts, supplies, travel, equipment, rental, printing, and other costs to support:

• Professional development and training for recipient-level staff;

• Model affiliation and accreditation fees;

• Continuous quality improvement and assurance activities, including development of CQI and related plans (with the exception of proposed CQI activities outlined in a HRSA-approved CQI Plan budgeted with any remaining requested funds from the $200,000 supplement included in the award ceiling total, as applicable;

see Section IV and Appendix C for guidance);

• Technical assistance provided by the recipient to the local implementing agencies (LIAs);

• Information technology including data systems (excluding costs incurred to update data management systems related to the HRSA redesign of the MIECHV program performance measurement system which took effect on October 1, 2016);

• Coordination with comprehensive statewide early childhood systems; and

• Indirect costs (also known as “facilities and administrative costs”) (i.e., costs incurred for common or joint objectives that cannot be identified specifically with a particular project, program, or organizational activity).25

NOTE: The limit on recipient-level infrastructure expenditures has no bearing on the negotiated indirect cost rate.

24 Social Security Act, Title V, § 511(i)(2)(C).

25 See p. II-26 of the HHS Grants Policy Statement.

https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf

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The 25 percent limit on recipient-level infrastructure expenditures does NOT include costs incurred for:

• State-led evaluation activities;

• Update of data management systems related to the HRSA redesign of the

MIECHV Program performance measurement system, which took effect in FY 2017, or related to measurement and data system redesign by model developer(s); and

• $200,000 supplement funds (included in the award ceiling total) provided for completion of an update to the statewide needs assessment. Any remaining requested supplemental funds not allocated towards completing an update to a needs assessment must be budgeted for CQI activities as outlined in an approved CQI Plan. See Appendix B for more information.

By contrast, service delivery expenditures that are NOT recipient-level infrastructure expenditures and therefore are not subject to the 25 percent limit may include:

• Contracts to LIAs;

• Professional development and training for LIA and other contractual staff (NOTE:

these expenditures should not be budgeted for professional development and training that is duplicative in scope or content of the professional development and training provided by other sources, including LIAs and home visiting model developers);

• Assessment instruments/licenses;

• Participant incentives; and

• Participant recruitment.

Recipients must use reasonable efforts to ascertain what constitutes recipient-level infrastructure expenditures necessary to enable delivery of MIECHV services in accordance with program activities and expectations, to document their findings in this regard, and to maintain records that demonstrate that such expenses do not exceed 25 percent of the award amount.

To obtain HRSA approval for spending more than 25 percent of the award amount on recipient-level infrastructure expenditures, including administrative costs, a recipient must provide written justification for this request. This justification should be included within the budget justification. Recipients should maximize efficiencies in infrastructure expenditures to increase the proportion of the FY 2018 award budgeted for home visiting services costs.

Pay for Outcomes The Bipartisan Budget Act of 2018 provides authority for recipients to use a MIECHV grant for a pay for outcomes initiative,26 which is defined as a performance-based grant, contract, cooperative agreement, or other agreement awarded by a public entity in which a commitment is made to pay for improved outcomes achieved as a result of the intervention that result in social benefit and direct cost savings or cost avoidance to the public sector. Such an initiative shall include:

26 Social Security Act, Title V, § 511(c), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50605.

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• A feasibility study that describes how the proposed intervention is based on evidence of effectiveness;

• A rigorous, third-party evaluation that uses experimental or quasi-experimental design or other research methodologies that allow for the strongest possible causal inferences to determine whether the initiative has met its proposed outcomes as a result of the intervention;

• An annual, publicly available report on the progress of the initiative; and

• A requirement that payments are made to the recipient of a grant, contract, or cooperative agreement only when agreed upon outcomes are achieved, except that this requirement shall not apply with respect to payments to a third party conducting the evaluation.

In accordance with statute and future guidance expected to be released no earlier than the Notice of Funding Opportunity for FY 2019 formula funds, recipients will be able to use up to 25 percent of the grant for outcomes or success payments related to a pay for outcomes initiative that will not result in a reduction of funding for home visiting services delivered by the entity while the eligible entity develops or operates such an initiative.

Funds made available for this specific purpose shall remain available for expenditure for not more than 10 years after the funds are so made available. FY 2018 formula funds should not be budgeted for a pay for outcomes initiative given the need to demonstrate adherence to statutory requirements for such an initiative. See Narrative for additional guidance on a pay for outcomes initiative.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a formula grant.

2. Summary of Funding

HRSA expects to award up to $351.0 million by formula and up to $11.2 million as supplement funds to 56 recipients. HRSA will communicate via HRSA Electronic Handbooks to each eligible applicant the estimated total grant award ceiling for each state, territory, and jurisdiction. The period of performance is September 30, 2018 through September 30, 2020 (2 years). Funding is dependent on 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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Formula The following formula is applied to FY 2018 funding available to states and territories (up to $351.0 million):

• Need Funding–Up to $123.0 million of the grant allocation available under this funding opportunity is distributed based on the proportion of children under five living in poverty as calculated by the Census Bureau’s Small Area Income and Poverty Estimates (SAIPE). 2016 SAIPE data will be used. Since SAIPE data are not available for territories, the Puerto Rico Community Survey (PRCS) data will be used as a proxy to determine need funding for Puerto Rico.

The calculated amount is subtracted by the proportion of the FY 2014 de-obligation amount to the total FY 2014 award, as reported to HRSA as of February 9, 2018, if applicable.

There is a $1.0 million minimum need-based award for recipients.

• Base Funding–Up to $228.0 million of the grant allocation available under this funding opportunity is proportionally distributed based on each awardee’s base funding portion of the FY 2017 formula grant award ceiling amounts.

• Guard Rails—In an effort to maintain stability, the total amount for which an applicant may apply will be adjusted, where appropriate, to ensure that any available recipient funding does not fluctuate by more than 7.5 percent from the prior year award.

You should request FY 2018 formula funds to support a proposed caseload of MIECHV family slots through use of one or more evidence-based models eligible for implementation under MIECHV or a home visiting model that qualifies as a promising approach. (See Section VIII for a list of evidence-based models eligible for implementation under MIECHV that meet the HHS-established criteria for evidence of effectiveness.) Based on review of the application, HRSA program staff and grants management officials will either approve or request clarification to the proposed caseload of MIECHV family slots by fiscal year and any proposed model enhancement(s). (See Section I for more information about model enhancements.)

The funding award is dependent upon the approved, agreed upon plan. Recipients should remember that inability to meet proposed caseloads may result in de-obligated funds, which may impact future funding.

The caseload of MIECHV family slots (associated with the maximum service capacity) is the highest number of families (or households) that could potentially be enrolled at any given time if the program were operating with a full complement of hired and trained home visitors. All members of one MIECHV family or household represent a single MIECHV caseload slot. The count of slots should be distinguished from the cumulative number of enrolled families during the reporting period. It is known that the caseload of MIECHV family slots may vary by federal fiscal year pending variation in available funding in each fiscal year.

HRSA recognizes that recipients may utilize a number of funding streams and use different administrative practices for assigning and reporting MIECHV family slots. For

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the purposes of reporting to HRSA on performance reporting Forms 1, 2, and 4, a “MIECHV family” is defined as a family served during the reporting period by a trained home visitor implementing services with fidelity to the model and that is identified as a MIECHV family at enrollment. (See Section VI for detail regarding annual and quarterly performance reporting.) HRSA has identified two different methods that can be used to identify MIECHV families that are described below:

1. Home Visitor Personnel Cost Method (preferred method): Families are designated as MIECHV at enrollment based on the designation of the home visitor they are assigned. Using this methodology, recipients designate all families as MIECHV that are served by home visitors for whom at least 25 percent of his/her personnel costs (salary/wages including benefits) are paid for with MIECHV funding.

2. Enrollment Slot Method (temporary option available until at least the end of the FY 2018 project period, September 30, 2020): Families are designated as MIECHV families based on the slot they are assigned to at enrollment. Using this methodology, recipients identify certain slots as MIECHV-funded and assign families to these slots at enrollment in accordance with the terms of the contractual agreement between the MIECHV state recipient and the LIA regardless of the percentage of the slot funded by MIECHV.

The Home Visitor Personnel Cost Method is consistent with the current definition of caseload of MIECHV family slots first identified in the MIECHV 2016 Formula Funding Opportunity Announcement (HRSA-16-172) and is HRSA’s preferred method.

Recipients may request to utilize the Enrollment Slot Method as a temporary option available until at least the end of the FY 2018 project period, September 30, 2020, by including a justification as Attachment 13 for using this approach. Once designated as a MIECHV family, the family is tracked for the purposes of data collection through the tenure of family participation in the program. Recipients must identify their method and define their maximum service capacity based on the method chosen. (See Section IV for instructions on identifying the method and submitting a justification if needed.)

Requesting FY 2018 Funds HRSA will communicate via HRSA Electronic Handbooks to each eligible applicant the estimated total grant award ceiling. This amount will include the $200,000 supplement for eligible entities to update the statewide needs assessment by the statutory deadline of October 1, 2020, in addition to the formula award available to you. You will not receive more than the total grant award ceiling and, therefore, may not apply for more than the total grant award ceiling.

No more than $200,000 of MIECHV grant funds may be budgeted to complete the needs assessment update. Any remaining requested supplement funds not allocated towards completing a needs assessment update must be budgeted for CQI activities as outlined in a HRSA-approved CQI Plan. See Section IV and Appendix C for guidance.

Per the authorizing statute, except as otherwise provided by law, funds made available to an eligible entity under this section for a fiscal year shall remain available for expenditure by the eligible entity through the end of the second succeeding fiscal year

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after award.27 Therefore, the project/budget period for these grants will be September 30, 2018 through September 30, 2020 (2 years). FY 2018 grant funds that have not been obligated for expenditure by the recipient during the period of availability (September 30, 2018 to September 30, 2020) will be de-obligated. You must provide a budget that describes the expenditure of grant funds at all points during the period of availability. You are not required to maintain the same rate of expenditure or the same level of home visiting services throughout the full period of availability but must demonstrate that home visiting services will be made available throughout the period of performance (the full period of availability).

Due to the legislative requirement pertaining to the period of availability for use of funds by recipients (Social Security Act, Title V, § 511(j)(3)), recipients will not be permitted a no-cost extension of the period of availability for use of such funds.

Full funding is also dependent on a history of satisfactory recipient performance on prior MIECHV grants and a decision that continued funding is in the best interest of the Federal Government. HRSA staff will review recipients’ FY 2014 de-obligated funding, programmatic and fiscal corrective action plans, and drawdown restriction. Recipients with more than 25 percent de-obligation of funds in FY 2014 as well as those on corrective action plans and/or drawdown restriction must provide a plan to describe how they are addressing identified issues now and in the future. HRSA will review and approve the plan, or request clarification if needed. Technical assistance will be available to recipients to support implementation of their plans. Increased monitoring by HRSA Project Officers may be required. If no plan is submitted, or the plan is not approved by HRSA, then the award may be reduced. For example, awards may be reduced at a proportion up to the portion of the FY 2014 award that was de-obligated, or the recipient may be subjected to drawdown restriction.

Effective December 26, 2014, all administrative and audit requirements and the cost principles that govern federal monies associated with this award will be subject to…