PKG00258249-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

Telehealth Network Grant Program

Funding Opportunity Number: HRSA-20-036

Funding Opportunity Types: New; Competing Continuation Assistance Listings (CFDA) Number: 93.211

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

MODIFIED on February 11, 2020: Cover, Executive Summary, and Section IV.4-Corrected the Application Due Date.

Application Due Date: April 13, 2020

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: February 11, 2020

Carlos Mena, MS Public Health Analyst, Federal Office of Rural Health Policy Telephone: (301) 443-3198 Email: cmena@hrsa.gov mailto:cmena@hrsa.gov

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Authority: Section 330I(d)(1) of the Public Health Service Act (42 USC 254c-14(d)(1)), as amended.

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Telehealth Network Grant Program (TNGP).

The purpose of this program is to demonstrate how telehealth networks are used to: (a) expand access to, coordinate, and improve the quality of health care services; (b) improve and expand the training of health care providers; and/or (c) expand and improve the quality of health information available to health care providers, and patients and their families, for decision-making. In particular, this funding opportunity is aimed towards promoting rural Tele-emergency services by enhancing telehealth networks to deliver 24-hour Emergency Department (ED) consultation services via telehealth to rural providers without emergency care specialists.

Funding Opportunity Title: Telehealth Network Grant Program Funding Opportunity Number: HRSA-20-036 Due Date for Applications: April 13, 2020 Anticipated Total Annual Available FY 2020 Funding:

$8,700,000

Estimated Number and Type of Awards: Up to 29 grants Estimated Award Amount: Up to $300,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: No Period of Performance: September 1, 2020 through

August 31, 2024 (4 years) Eligible Applicants: Eligible applicants include public and private non-profit entities, including faith-based and community organizations, as well as federally-recognized Indian tribal governments and organizations.

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

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Application Guide

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

Technical Assistance

The Federal Office of Rural Health Policy will hold a technical assistance webinar on Monday, February 24, 2020 at 2-3:30 p.m. Eastern Standard Time to assist applicants in preparing their applications. The technical assistance webinar is open to the general public.

The purpose of the webinar is to review the NOFO, and to provide clarifying information that may be necessary. There will be a Q & A session at the end of the call to answer any questions. FORHP strongly recommends that potential applicants thoroughly read this NOFO prior to the webinar and have the NOFO available during the webinar. While participation on the webinar is not required, it is highly recommended that anyone who is interested in applying for this program plan to attend the webinar. FORHP has found that it is most useful to the applicants when the NOFO is easily accessible during the webinar and questions are written down ahead of time for easy reference.

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Monday, February 24, 2020 Time: 2-3:30 p.m. ET Call-In Number: 1-888-843-6163 Participant Code: 6066171 Weblink: https://hrsa.connectsolutions.com/telehealth_network_grant/ Playback Number: 1-800-873-1933 Passcode: 3192 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/telehealth_network_grant/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative V. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: COMMON DEFINITIONS

APPENDIX B: USEFUL RESOURCES

APPENDIX C: TELEHEALTH NETWORK GRANT PROGRAM (TNGP) PERFORMANCE

MEASURES FOCUSING ON TELE-EMERGENCY SERVICES PERFORMANCE

IMPROVEMENT AND MEASUREMENT SYSTEM (PIMS)

APPENDIX D: PERFORMANCE MEASURES TELEHEALTH NETWORK GRANT

PROGRAM (TNGP) PERFORMANCE IMPROVEMENT AND MEASUREMENT SYSTEM

(PIMS)

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Telehealth Network Grant Program (TNGP). The funding opportunity is aimed towards promoting rural Tele-emergency services with an emphasis on tele-stroke, tele-behavioral health, and Tele-Emergency Medical Services (Tele-EMS). This will be achieved by enhancing telehealth networks to deliver 24-hour Emergency Department (ED) consultation services via telehealth to rural providers without emergency care specialists.

Tele-emergency is defined as “an electronic, two-way, audio/visual communication service between a central emergency healthcare center (Tele-emergency hub) and a distant hospital emergency department (ED) (remote ED) designed to provide real-time emergency care consultation.”1 These services may include assessment of patients upon admission to the ED, interpretation of patient symptoms and clinical tests or data, supervision of providers administering treatment or pharmaceuticals, or coordination of patient transfer from the local ED.

The overarching goals for the Telehealth Network Grant Program are to:

• Expand access to, coordinate, and improve the quality of health care services;

• Improve and expand the training of health care providers; and

• Expand and improve the quality of health information available to health care providers, and patients and their families, for decision-making.

In addition, TNGP recipients will support a range of Tele-emergency service programs that will allow for the analysis of a significant volume of patient encounters. The goal is for each TNGP recipient, under this NOFO, to analyze the provision of Tele-emergency services under common metrics and protocols that will allow for a multi-site analysis of the effectiveness of those services. Each of the recipients will participate in a broad-scale analysis and evaluation of the program coordinated by the Federal Office of Rural Health Policy (FORHP) as well as individual award recipient analysis and evaluation.

2. Background

This program is authorized by Section 330I(d)(1) of the Public Health Service Act (42 USC 254c-14(d)(1)), as amended. The Federal Office of Rural Health Policy (FORHP) is the focal point for rural health activities within HHS.

The Office for the Advancement of Telehealth (OAT) is located within FORHP and supports a wide range of telehealth activities, including the TNGP.

The focus on Tele-emergency services for the TNGP is a result of research that supports the effectiveness of tele-stroke and tele-behavioral health and evidence that

1 MacKinney, A. Clinton MacKinney, Marcia M. Ward, Fred Ullrich, Padmaja Ayyagari, Amanda L. Bell, and Keith J.

Mueller. 2015. “The Business Case for Tele-emergency.” Telemedicine and e-Health 201, no. 21 (December):

1005-1011. https://DOI.org/10.1089/tmj.2014.0241.

https://doi.org/10.1089/tmj.2014.0241

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indicates a low volume of telehealth utilization of services in emergency departments.

Over the course of two decades, hospital charges have increased significantly for ED care2. And, according to the Center for Disease Control and Prevention, across a 15 year period, the number of Emergency Department (ED) visits increased by 34 percent (from 97 million to 130 million), but at the same time, the number of EDs in the U.S.

decreased by 11 percent, greatly exceeding capacity at many existing EDs3. A recent study states “76 percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology.”4 However, telehealth services are only being delivered to about 8 percent of emergency departments (ED).5 Most recent research suggests telehealth consultations may be able to reduce mortality for patients with heart attacks, and can also reduce a patient’s wait time in an ED6. It has also been determined that telehealth “has the potential to reduce the number of transfers from rural emergency departments, retaining some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings”.7

OAT defines telehealth as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. This authorization states that grant activities must serve rural communities, although applicants may be located in either urban or rural areas.

To learn more about previously and currently funded Office for the Advancement of Telehealth projects, including the Telehealth Network Grant Program projects, please see the latest profiles. You may also find evidence-based toolkits (e.g., obesity prevention, care coordination, mental health and substance abuse, etc.) and program models at https://www.ruralhealthinfo.org/community-health.

Applicants are also encouraged to visit the HRSA Training and Technical Assistance Hub website, which houses all HRSA training and technical assistance resources to extend the reach of our training and technical assistance resources and further the impact of HRSA award recipients and stakeholders. Resources are organized by topic and some resources may be listed under multiple topics.

2 Selden, Thomas M. 2020. “Differences Between Public And Private Hospital Payment Rates Narrowed, 2012–16.”

Health Affairs 39 (January): 94-99. https://doi.org/10.1377/hlthaff.2019.00415.

3 Centers for Disease Control and Prevention. Health, United States, 2012: With Special Feature on Emergency Care. Washington, DC: 2013 https://www.cdc.gov/nchs/data/hus/hus12.pdf 4 American Hospital Association. February 2019. Fact Sheet: Telehealth. Accessed May, 2019, https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf 5 Mueller, Keith J., Andrew J. Potter, A. Clinton MacKinney, and Marcia M. Ward. 2014. “Lessons from Tele-emergency: Improving Care Quality and Health Outcomes by Expanding Support for Rural Care Systems. Health Affairs 33 (February): 228-234. https://doi.org/10.1377/hlthaff.2013.1016.

6 Agency for Healthcare Quality and Research. Comparative Effectiveness Review Number 216: Telehealth for Acute and Chronic Care Consultations. Washington, DC: 2019 https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-216-telehealth-final-report.pdf 7Natafgi, Nabil, Dan M. Shane, Fred Ullrich, A. Clinton MacKinney, Amanda Bell, Marcia M. Ward. 2017. “Using

Tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits.”

Journal of Telemedicine and Telecare 24 (March): 193-201. https://doi.org/10.1177/1357633X17696585.

https://www.hrsa.gov/sites/default/files/hrsa/ruralhealth/resources/telehealth/oat-grantees-2017-profiles.pdf https://www.ruralhealthinfo.org/community-health https://www.hrsa.gov/library/index.html https://www.hrsa.gov/library/index.html https://doi.org/10.1377/hlthaff.2019.00415 https://www.cdc.gov/nchs/data/hus/hus12.pdf https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf https://doi.org/10.1377/hlthaff.2013.1016 https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-216-telehealth-final-report.pdf https://doi.org/10.1177/1357633X17696585

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II. Award Information

1. Type of Application and Award

Types of applications sought: New, Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $300,000 to be available annually to fund up to 29 recipients. You may apply for a ceiling amount of up to $300,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 1, 2020 through August 31, 2024 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for TNGP in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

Applicants who receive funding from HRSA for the TNGP program but fail to bring on board network partners as indicated in their applications may receive administrative sanctions, including terminations or reductions in awards in future funding years.

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

The limitation on indirect cost rates is 15 percent (Section 330I(l)(7) of the Public Health Service Act).

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include rural or urban nonprofit entities that will provide direct clinical services through a telehealth network. Each entity participating in the networks may be a nonprofit or for-profit entity. Faith-based, community-based organizations and tribal organizations are eligible to apply. Services must be provided to rural areas, although the applicant can be located in an urban area.

A. Geographic Requirements:

The applicant organization and Telehealth Network’s Distant Site(s) may be located in an urban or rural area but Telehealth Network’s Originating Site(s) (see Appendix A for definition) must be in rural areas in order to receive funds through this award. Urban Originating Site(s) are NOT eligible to receive grant funding through this award. Specifically, the applicant’s proposed Originating Site must be located in a non-metropolitan county or in a rural census tract of a metropolitan county. All services must be provided in a non-metropolitan county or rural census 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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tract. To ascertain rural eligibility, please refer to HRSA’s Rural Health Grants Eligibility Analyzer. This webpage allows you to search by county or street address and determine your rural eligibility. If the proposed Originating Site Organization is owned by or affiliated with an urban entity or health care system, the rural component may still apply as long as the rural entity has its own Employer Identification Number (EIN) and can directly receive and administer the award funds in the rural area.

In addition to the 50 states, only organizations in Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are eligible.

B. Composition of the Telehealth Network:

The telehealth network shall include at least two (2) of the following entities (at least one of which shall be a community-based health care provider):

a. Community or migrant health centers or other Federally Qualified Health Centers.

b. Health care providers, including pharmacists, in private practice.

c. Entities operating clinics, including rural health clinics.

d. Local health departments.

e. Nonprofit hospitals, including community access hospitals.

f. Other publicly funded health or social service agencies.

g. Long-term care providers.

h. Providers of health care services in the home.

i. Providers of outpatient mental health services and entities operating outpatient mental health facilities.

j. Local or regional emergency health care providers.

k. Institutions of higher education.

l. Entities operating dental clinics.

The applicant’s proposed telehealth network may also consist of other entities such as rural emergency departments (ED), emergency medical services (EMS) that serve rural populations and ambulances that serve rural entities.

For-profit organizations are not eligible to be the applicant organization but are eligible to be a rural Originating Site. However, any proposed for-profit Distant Site, or Originating Site (Appendix A), are NOT allowed to receive TNGP award dollar support.

C. Proof of Nonprofit or Public Status

One of the following documents must be included in Attachment 11: Proof of Non-profit Status to document the applicant’s nonprofit status (will not count toward the page limit):

https://data.hrsa.gov/tools/rural-health?tab=Address

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• A letter from the IRS stating the organization’s tax-exempt status under Section 501(c)(3);

• A copy of a currently valid IRS tax exemption certificate;

• Statement from a state taxing body, state attorney general or other appropriate state official certifying that the applicant organization has a nonprofit tax status and that none of the next earnings accrue to any private shareholders or individuals;

• A certified copy of the organization’s certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization; or

• If the applicant is an affiliate of a parent organization, a copy of the parent organization’s IRS 501(c)(3) Group Exemption Letter, and if owned by an urban parent, a statement signed by the parent organization that the applicant organization is a local nonprofit affiliate.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

NOTE: Multiple applications from an organization are not allowable.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Current and former Telehealth Network Grant Program recipients are eligible to apply for funds through this announcement for the FY 2020 cycle if the proposed project is a new proposal (entirely new project). If previously funded through the TNGP, then the new TNGP proposed project should not supplant an existing program.

The proposal should differ significantly from the previous projects by expanding the service area of the project and providing a new service(s) to rural emergency departments.

In order to apply, if the applicant organization has a history of receiving funds under the Telehealth Network Grant Program award, they must propose a project that is different from what the previously funded project and have two (2) new network members.

Applicants must submit abstracts from previous Telehealth Network Grant Program awards in Attachment 5.

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Each state has a State Office of Rural Health (SORH), and the Federal Office of Rural Health Policy recommends contacting the SORH entity early in the application process to advise them of your intent to apply. The SORH may be able to provide some consultation to you including information on model programs, data resources, technical assistance for consortiums, evaluation, introductions to partner organizations, or support of information dissemination activities. A TNGP applicant should make every effort to seek consultation from its State Office of Rural Health.

Applicants are also encouraged to reach out to their regional Telehealth Resource Center and one of the two HRSA Telehealth Centers of Excellence. They serve as national clearinghouses for telehealth research and resources, including technical assistance.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including modifications and/or republications of the NOFO on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace https://www.telehealthresourcecenter.org/who-your-trc/ https://www.telehealthresourcecenter.org/who-your-trc/ https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You, on behalf of the applicant organization certify, by submission of your proposal, that neither you nor your principals are 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 you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 13: Other Relevant Documents.

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

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

i. Project Abstract

See Section 4.1.ix of HRSA’s SF-424 Application Guide. The project abstract must be single-spaced, and limited to one page in length. Please include the following information at the top of the abstract:

a. Project title;

b. Applicant organization name;

c. Applicant organization address (street, city, county, state, ZIP code);

d. Applicant organization website, if applicable;

e. Requested award amount;

f. Applicant organization facility type (See Section III.1.B for examples);

g. Project Director name and title;

h. Project Director contact information (phone and e-mail);

i. Funding Preferences – A funding preference will be granted to any qualified applicant that specifically requests the preference and meets the criteria for the preference listed (see Section V.2). If you are requesting a funding preference, please state it here.

j. Service Area – Briefly identify the geographic service area that the telehealth network serves or will serve, including its size and population. Note how many full and partial Health Professional Shortage Areas (HPSAs) and full and partial http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Medically Underserved Areas (MUAs) the service area contains. Also, note any mental health and/or dental HPSAs. Note any other critical characteristics of the service area and its population.

k. Needs, Objectives, and Projected Outcomes – Briefly describe the identified needs and expected demand for services, project objectives, and expected outcomes.

l. Indicate the number of rural Originating Sites to be supported through this TNGP opportunity.

m. Clinical Services to be provided – List proposed clinical services.

n. Actual Patients/Persons Served – Specify the actual number of unduplicated patients/ persons served throughout 2019 (January 1 – December 31, 2019) at the Network Sites proposed for the Tele-emergency TNGP project. Estimate (by site and year) the number of unduplicated patients/persons to be served at each network site during the first year of the program and in subsequent years 2, 3, and 4.

o. Self-Assessment – Briefly describe how the applicant plans to measure their progress achieving the goals stated in their application.

p. Outcomes - Telehealth Services – Describe the project’s anticipated added value to healthcare using telehealth resulting from the evaluation of the proposed services (e.g., clinical Tele-emergency).

q. Additional Activities – Describe any additional services and activities for which the network is being utilized or will be utilized and include an estimated amount of time (administrative meetings, community meetings, etc.). Note: Applicants that strictly propose such additional services, and exclude direct delivery of clinical services to patients in rural communities, via telemedicine, will not be considered eligible for award funding support (Section III.3).

r. Sustainability – Briefly describe activities to sustain the telehealth network once federal funding ends.

s. Indicate if you are a recipient of a current TNGP award, and whether you serve/d as the applicant organization or a Originating Site;

t. Indicate whether you have applied for a TNGP award, and whether you applied as the applicant organization or an Originating Site;

u. How the applicant learned about this funding opportunity (e.g., Telehealth Resource Centers, State Office of Rural Health, Grants.gov, HRSA news release, FORHP weekly announcements, etc.).

ii. Project Narrative

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

Applicants are encouraged to focus on tele-stroke, tele-behavioral health, and tele- EMS, and other telehealth clinical service area(s) they will provide to rural emergency departments. Applicants may also incorporate telehealth into an ambulance setting as it relates to coordination with tele-stroke, tele-behavioral health, and tele-EMS in the emergency department setting. In doing so, applicants will be required to set a

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baseline of data for those conditions that are the focus of their projects and then measure how their use of telehealth services affects the health status of those emergency department patients and the cost-effectiveness of the telehealth services provided. It should be emphasized that the TNGP will seek to select projects that have demonstrated skill in evaluation. In addition, applicants must show evidence of successful records of accomplishments in providing telehealth services in emergency departments and demonstrate how the proposed funds will expand services to new communities and/or populations.

Applicants must also provide a thorough description of their technical expertise and experience in taking part in broad quantitative evaluations and describe how their staffing plans will contribute to the larger program evaluation. Tele-emergency recipients will report data on HRSA Metrics provided in Appendix C and Appendix D.

Lastly, all TNGP recipients will work closely with Technical Assistance (TA) providers throughout the four-year period of performance. The targeted TA will assist recipients with achieving TNGP program outcomes and will focus on planning for sustainability beyond the period of performance. This TA will be provided to recipients at no additional cost. This support is an investment made by FORHP in order to ensure the success of the awarded projects. FORHP has found that most recipients benefit greatly from the support provided through TA collaborations.

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

INTRODUCTION -- Corresponds to Section V’s Review Criteria #1 Need

This section should succinctly describe the purpose of the proposed project and how the project will expand its Tele-emergency services to help analyze the clinical effectiveness of this application of telehealth technology to support improved emergency medical outcomes for small rural hospitals and the underserved populations they serve. The section should also describe how the project will generate significant patient encounters across proposed rural Originating Sites to help inform a broad-scale evaluation and analysis. You should also provide an overview of the organization and activities of your current Tele-emergency network and how they relate to the proposed project. This section should explain how this project will rely on lessons learned from previous telehealth and Tele-emergency research and the applicant’s previous experience in providing Tele-emergency services.

The applicant should also provide evidence of success in prior initiatives and specify, for 2019:

• The actual number of unduplicated patient served during Calendar Year 2019 at the sites that would participate in the Tele-emergency TNGP project.

• List the projected number of unduplicated patients to be served at each of the

Originating Sites during the first year of the period of performance.

• Provide an estimate of the projected number of unduplicated patients to be served at each of the Originating Sites for year 2, 3, and 4.

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Applicants that receive a TNGP award will be required to report annual data into the Performance Improvement Measurement System (PIMS) common telehealth measures (Appendix D) to help monitor recipient respective projects. In addition, applicants will be required to report data to specific Tele-emergency measures outlined in Appendix C. These measures would demonstrate health status improvement and include baseline data. Baseline PIMS and Tele-emergency data will be reported 60 days after the period of performance start date.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criteria #1 Need

This section should describe the community and provider needs that will be met through the proposed Tele-emergency project. This section should present evidence of significant demand for specialized emergency care among practitioners and patients in the network’s service area. Demand may be demonstrated by statistics showing elevated bypass of or transfer rates from proposed Originating Rural Sites and patient volumes across the network to generate a significant number of patient encounters. The applicant should demonstrate that this demand would be met through the proposed project. The application should provide a clear explanation and justification of how existing Network Sites were included and how they will provide the sufficient volume of patient encounters to inform an evidence-based evaluation and analysis.

The target population of the project must be sufficiently large to permit rigorous analysis. Please use the following three sub-headings in this section as you complete your narrative: 1) Target Population Details, 2) Program Development/Target Population Involvement, and 3) Tele-emergency care in Service Area.

1) Target Population Details:

a. Describe the target population. Consider any disparities based on race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, health literacy, and other relevant elements. You should also consider populations that may otherwise be overlooked when identifying target populations.

b. Describe the population’s demographics using quantitative data from appropriate sources (e.g., local, state, tribal, and federal), and identify the target rural service area, and describe the target population to be served by this project. Where possible, compare population demographics to data for the general population regionally, statewide, and/or nationally. At a minimum, include the following information for the target rural service area:

i. Total population size;

ii. Percentage of target population with health insurance coverage and estimated proportion of major payers within this population (e.g., any commercial health plan, Medicare, HRSA-20-036 11

Medicaid, dual Medicare- Medicaid, CHIP, TRICARE, Indian Health Service, uninsured/self- pay, etc.);

iii. Percentage of target population without health insurance coverage that is likely eligible for health insurance coverage;

iv. Percentage of target population living below the federal poverty line;

v. Percentage of target population who are unemployed;

vi. Breakdown of target population by race/ethnicity; and

vii. Breakdown of target population by sex and age.

2) Program Development/Target Population Involvement:

a. Describe how the needs of the target population were identified.

Further, describe the involvement of the target population in the project development and future plans to ensure the project is responding to the target population’s needs.

b. Discuss the manner and degree to which the target population was included in planning for the activities of the project. Also, describe the involvement of representatives of local, regional, tribal and/or state government that were involved in the planning process, as well as the involvement of local non-government organizations.

3) Tele-emergency care in Service Area:

a. Describe the Tele-emergency services available in or near the target service area. How does the proposed project complement the current services in the community?

b. Describe the potential impact of the project on existing providers who are not part of the project (e.g., changes in referral patterns, practice patterns, provider reimbursement impact, etc.) and the community (e.g., economic impact etc.). Include a map within the narrative that shows the location of Tele-emergency network members, the rural geographic area served by the network, and any other information that will help reviewers visualize and understand the scope of the proposed activities (Attachment 13).

c. Describe how this project will address a health gap in the community that would not otherwise have been addressed if it were not for this award opportunity.

METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 Response

This section outlines the methods that the applicant organization will use to address the stated need and meet each of the previously described program requirements and expectations in this NOFO.

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The following headings must be addressed within the methodology sections.

Please address these headings: “Methods for Fulfilling Goals and Objectives”;

“Methods for Maintaining Rural Originating Site and Stakeholder Commitment”;

“Methods for Implementing a Promising Practice Model“; and “Methods for Sustaining Project Beyond Period of Performance”.

1. Methods for Fulfilling Goals and Objectives:

• Define the specific goals and objectives.

• The stated goals and objectives should be measurable and align with the intent to the TNGP period of performance.

• These goals and objectives should directly relate to the information presented in the prior section, or “Needs Assessment”.

• Collaborate and coordinate with state Medicaid agencies and other payers to explore payment and reimbursement options to support the Tele-emergency project, including potential methods for reducing costs.

• The modality by which Tele-emergency services will be delivered, including the required telecommunications infrastructure (e.g., equipment, bandwidth) required to support service delivery.

• Describe how the proposed project will promote the use of Tele-emergency care.

• Describe the process providers will use to determine whether telehealth services are needed when a patient presents at the ED.

• Describe whether the proposed project will be able to gather information in alignment with to-be determined measures related to changes in patient travel time, personal savings to patients through avoided transfer, rates of hospital admission, readmission, and transfer, transfer time to tertiary facilities, patient outcomes, performance on clinical quality measures, cost efficiency, and patient and provider satisfaction.

2. Methods for Maintaining Rural Originating Site and Stakeholder Commitment:

• Describe how your Tele-emergency network will maintain rural Originating Site commitment throughout the period of performance.

• Describe how the Tele-emergency network will build and maintain stakeholder involvement and commitment throughout period of performance.

3. Methods for Implementing a Promising Practice Model:

• Identify a promising practice model that has been shown to be effective in addressing Tele-emergency care in rural communities.

• Please describe how the promising practice model is appropriate for your proposed project, and effective in meeting the rural target population’s need.

4. Methods for Sustaining Project Beyond Period of Performance:

• Describe the methods by which you will sustain program activities beyond the period of performance. Some examples include:

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o Sustain the rural Originating Sites;

o Secure target population support and engagement;

o Maximize reimbursement for services across insurance types;

o Incorporate diverse strategies that include absorption of some activities by telehealth network partners (i.e., Originating Site takes on a award funded activity beyond the period of performance as part of their standard practice), earned income through third-party reimbursement or fees for services rendered, and other awards and charitable contributions;

• Describe some of the potential sources of support for achieving sustainability. Sources of support could include but are not limited to financial, in-kind, or the absorption of activities by telehealth network partners.

WORK PLAN -- Corresponds to Section V’s Review Criteria #2 Response and

#4 Impact

Describe the activities or steps that will be used to achieve each of the activities proposed during the entire period of performance in this section. Use a timeline that includes each activity and identifies responsible staff. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities. Provide a clear and coherent work plan that aligns with the project’s goals and objectives. Present a matrix that illustrates the project’s goals, strategies, activities, and measurable process and outcome measures (please provide this information in a table format). The work plan must outline the individual and/or organization responsible for carrying out each activity and include a timeline for all four-years of the award. The applicant should include the work plan as Attachment 3.

Describe the following elements for your project model:

1. Impact:

• Describe the expected impact on the target population and the state/regional telehealth network

• Describe the expected or potential long-term changes and/or improvements to the program. Examples of potential long-term impact could include:

o changes in morbidity and mortality, o maintenance of desired behavior, o policy implications, o reductions in social and economic burdens associated with uninsured status, o mitigation in access to care barriers

2. Dissemination Plan:

Describe the plans and methods for dissemination of project results.

You must include a plan that describes how the information collected throughout the period of performance will be disseminated to

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stakeholders. The dissemination plan should describe strategies and activities for informing respective target audiences and stakeholders (i.e., policymakers, research community, etc.) of project progress and results throughout the period of performance.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criteria #2 Response

Discuss potential challenges and approaches some examples may include:

a. Designing and implementing the activities described in the work plan, including the data collection and dissemination capacity at each rural Originating Site.

b. How new Telehealth Network Sites or expansion of existing Tele-emergency Sites will be integrated into their networks and begin service delivery.

c. Broadband and other infrastructural issues related to standing up the networks.

d. Addressing high start-up costs and encouraging patient and provider buy-in for services that will be delivered through the proposed project.

e. Low reimbursement under traditional payment structures and sustainability of the proposed project following end of period of performance.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criteria #3 Evaluative Measures

The program performance evaluation should be inclusive of ongoing Tele-emergency performance evaluation processes able to document progress towards proposed project goals and objectives. Which should include the following items:

a. A description which details the systems and processes planned to support management of project performance, including ability of the project to effectively track performance outcomes, how data will be collected and managed (e.g., assigned skilled staff, data management software, etc.) should also be included in response to this section.

b. Describe, as appropriate, the data collection strategies planned for the collection, analysis and tracking of project data to measure project process, outcomes and impact. Any potential obstacles identified for implementation of the proposed project’s performance evaluation, including how potential obstacles will be addressed should be provided in the description response to this section.

c. Applicants should clearly describe the process of staffing, workflow, and frequency by which quantitative and qualitative data/information for the measures outlined in Appendix C and Appendix D will be identified, collected, monitored, analyzed, secured, and utilized for quality improvement.

d. Describe the process and frequency by which evaluation results and lessons learned will be communicated to both internal and external audiences and how the applicant organization will leverage HRSA

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technical assistance resources to promote dissemination of this information.

FORHP TNGP Program Specific Performance Improvement Measurement System

(PIMS):

• FORHP developed standard measures to assess the impact that FORHP programs have on rural communities and to enhance ongoing quality improvement. FORHP has incorporated these performance measures as a requirement for all FORHP award programs in order to achieve the stated objectives. Recipients are required to report on the Performance Improvement Measurement System (PIMS) through HRSA’s Electronic Handbook (EHB) after each period of performance. Recipients will be required to provide data on these measures annually for continued funding (please see Appendix D). These PIMS measures are subject to change and final PIMS measures will be shared upon Notice of Award.

• In addition to the standard measures described above, the PIMS measures also include Tele-Emergency measures (Appendix C).

• All baseline PIMS data will be collected 60 days after the start of the period of performance.

• This reporting is also referenced in Section VI.3.3.

NOTE: TNGP award recipients will be expected to work with a HRSA-funded technical assistance provider during the period of performance (and potentially share project updates and information with them after the period of performance ends). HRSA will provide additional guidance on the technical assistance components of the project throughout the period of performance.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criteria

#5 Resources and Capabilities

This section provides insight into the organizational structure of the applicant’s existing and established telehealth network and its ability to implement the activities outlined in the work plan. As a reminder, for the purposes of TNGP, the composition of the telehealth network is defined as an arrangement among three or more separately owned domestic public or non-profit entities, including the applicant organization, with established working relationships, and at least two Originating Sites (required composition outlined in Section III.1.B.), that must be located in a HRSA-designated rural area (as defined by Rural Health Grants Eligibility Analyzer.

Applicants should include the following staffing and network information using the following subheadings: Telehealth Network Site Identification, Memorandum of Agreements, Organizational Chart, Resources and Capabilities, and Network Strength and Capacity:

1. Telehealth Network Site Identification: For each Telehealth Network Site, the applicant must include the following information (list the Applicant Organization Site first) in a table format (include as Attachment 4):

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a. Name of Site – List the name of the Telehealth Network Member Site;

b. Street Address – Include City, State and Zip Code;

c. Name of County;

d. Rural Site: Specify (yes/no) whether this site is located in a HRSA-designated rural county or rural census tract of an urban county, as defined by the Rural Health Grants Eligibility Analyzer;

e. Designated Point of Contact person, direct phone number, and primary email.

f. Site’s Uniform Resource Locator (URL).

g. Population of County where site is located;

h. Is this a Telehealth Network Originating Site (O) or Distant Site (D)? O/D

i. Do application attachment numbers 6 (MOA’s) & 10 (Letters of Support) contain evidence that each Network Member Site is committed to the project for Year 1? Yes/No;

j. Site Employee Identification Number (EIN). Tribal entities may be exempt from this requirement;

k. National Provider Identifier (NPI) and Primary Taxonomy if the site bills for service. See https://npiregistry.cms.hhs.gov/ . If the site name or address do not match the NPI registration, please explain;

l. Health Care Provider (HCP) number (if the site receives Universal Service funding). See http://www.usac.org/rhc ;

m. Indicate whether this is a currently active or new distant or originating site (Note: if a new site, indicate the year it will be added to the network);

n. Indicate whether the applicant site is located in the following areas:

i. An urban or rural area;

ii. A Health Professional Shortage Area (HPSA);

iii. A Partial Health Professional Shortage Area (p-HPSA);

iv. A Medically Underserved Area (MUA);

v. A Partially Medically Underserved Area (p-MUA).

o. Description of the site’s facility (Section III.1.B)

a. Community or migrant health centers or other Federally Qualified

Health Centers.

b. Health care providers, including pharmacists, in private practice.

c. Entities operating clinics, including rural health clinics.

d. Local health departments.

e. Nonprofit hospitals, including community access hospitals.

f. Other publicly funded health or social service agencies.

g. Long-term care providers.

h. Providers of health care services in the home.

i. Providers of outpatient mental health services and entities operating outpatient mental health facilities.

j. Local or regional emergency health care providers.

k. Institutions of higher education.

l. Entities operating dental clinics.

The applicant’s proposed…