PKG00264489-instructions.pdf

HRSA-21-009 i

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Primary Health Care

Native Hawaiian Health Care Improvement Act

Funding Opportunity Number: HRSA-21-009 Funding Opportunity Type(s): Limited Competition

Catalog of Federal Domestic Assistance (CFDA) Number: 93.932

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date in Grants.gov: March 15, 2021

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 one month to complete.

Issuance Date: December 14, 2020

Rael Ammon Management Analyst, Bureau of Primary Health Care Office of Policy and Program Development

(301) 594-4300 BPHC Contact Form NH Technical Assistance webpage:

https://bphc.hrsa.gov/program-opportunities/nhhcs

Authority: Native Hawaiian Health Care Improvement Act, as amended (42 U.S.C. 11701 - 11714) https://bphccommunications.secure.force.com/ContactBPHC/BPHC_Contact_Form https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Primary Health Care is accepting applications for the fiscal year (FY) 2021 Native Hawaiian Health Care Improvement Act (NHHCIA). The purpose of this grant program is to improve the provision of comprehensive disease prevention, health promotion, and primary care services to Native Hawaiians. Applicants are limited to Papa Ola Lokahi (POL) and Native Hawaiian Health Care Systems (NHHCS) certified by POL by the date of application, and that meet the eligibility requirements specified in Section III-1.

Funding Opportunity Title: Native Hawaiian Health Care

Improvement Act Funding Opportunity Number: HRSA-21-009 Due Date for Applications: March 15, 2021 Anticipated Total Annual Available FY21 Funding:

$16,999,696

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

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

Period of Performance: August 1, 2021 – July 31, 2024 (up to 3 years)

Eligible Applicants: Eligible applicants include POL and NHHCS certified by POL to serve one of the island communities listed in Table 1.

See Section III-1 of this 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.

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

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Technical Assistance

Application resources, as well as form samples and webinar information, are available at the NHHCIA technical assistance (TA) webpage (https://bphc.hrsa.gov/program-opportunities/nhhcs). Refer to “How to Apply for a Grant,” available at https://www.hrsa.gov/grants/apply-for-a-grant, for general (i.e., not NHHCIA specific) videos and slides on a variety of application and submission components.

Summary of Changes (compared to the FY 2018 NHHCIA)

• The term “project period” has been replaced with “period of performance.”

• Table 1 provides additional information regarding eligible applicants.

• Table 2 has been updated to include virtual care visits, where applicable.

• There are three new optional clinical performance measures (Depression

Remission at 12 months, Breast Cancer Screening, and HIV Screening) and one revised optional clinical performance measure (HIV Linkage to Care).

https://www.hrsa.gov/grants/apply-for-a-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 TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEM ENT (SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

TIPS FOR WRITING A STRONG APPLICATION

APPENDIX A: REQUIRED AND OPTIONAL ADDITIONAL SERVICES FOR NATIVE

HAWAIIAN HEALTH CARE SYSTEMS

APPENDIX B: PERFORMANCE MEASURES

APPENDIX C: INCOME ANALYSIS FORM INSTRUCTIONS

APPENDIX D: PROJECT UPDATE INSTRUCTIONS

HRSA-21-009 1

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

This notice announces the opportunity to apply for funding under the Native Hawaiian Health Care Improvement Act (NHHCIA) program. The NHHCIA, as amended (42 U.S.C.

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

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

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

This is a limited competition program announcement. This NOFO provides instructions to be used by POL and certified NHHCS under the NHHCIA in preparing applications for funding for fiscal years 2021 through 2023.

2. Background

This program is authorized under the NHHCIA, as amended (42 U.S.C. 11701 - 11714).

The Native Hawaiian population experiences barriers to accessing health care services that significantly impact overall health status. Geographic isolation from health services is also a serious barrier for many Native Hawaiians.

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

Funding Requirements

NATIVE HAWAIIAN HEALTH CARE SYSTEMS (NHHCS)

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

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

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

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

(D) Immunizations;

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

(F) Pregnancy and infant care; and (G)Improvement of nutrition.

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

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

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

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

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

11711], as excerpted below.

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

a) Immunizations;

b) Control of high blood pressure;

c) Control of sexually transmittable diseases;

d) Prevention and control of diabetes;

e) Control of toxic agents;

f) Occupational safety and health;

g) Accident prevention;

h) Fluoridation of water;

i) Control of infectious agents; and

j) Provision of mental health care.

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

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

b) Cessation of tobacco smoking;

c) Reduction in the misuse of alcohol and drugs;

d) Improvement of nutrition;

e) Improvement in physical fitness;

f) Family planning;

g) Control of stress; and

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

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42 U.S.C. 11711(8) Primary Health Services The term “primary health services” includes:

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

b) Diagnostic laboratory and radiologic services;

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

d) Emergency medical services;

e) Transportation services as required for adequate patient care;

f) Preventive dental services; and

g) Pharmaceutical services, as may be appropriate.

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

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

PAPA OLA LOKAHI (POL)

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

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

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

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

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

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

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

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

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

Native Hawaiians;

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

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

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

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

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

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

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

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

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

11711(7)]).

NHHCS and POL

HRSA encourages you to propose activities that promote health equity by addressing social determinants of health (SDOH). SDOH include factors like socioeconomic status, neighborhood and physical environment, social support networks, community violence, and intimate partner violence. SDOH affect a wide range of health, functioning, and quality-of-life outcomes and risks. Addressing SDOH, such as intimate partner violence, is a HRSA objective to improve the health and well-being of individuals and the communities in which they reside.

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

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: Competing Continuation and New.

• Competing Continuation applicants are current NHHCIA award recipients who are applying to continue their NHHCIA funding. These applicants are listed by name in Table 1.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 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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• New applicants are service delivery organizations not currently funded through the NHHCIA, but are certified by POL to serve one or more of the island communities listed in Table 1.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

Approximately $17 million is expected to be available annually to fund six recipients. The actual amount available will not be determined until enactment of the final FY 2021 federal appropriation. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is August 1, 2021 through July 31, 2024 (3 years). For the purpose of this application, you may apply for the ceiling amount listed in Table 1 (includes both direct and indirect, facilities and administrative costs) per year. However, the ceiling amount for each award recipient may vary for each future budget period within the period of performance and will be announced through the Non-Competing Continuation instructions document. Funding beyond the first year is dependent on the availability of appropriated funds for the NHHCIA program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

Table 1: Maximum Awards for FY 2021 Applicant Type Eligible Organizations Maximum

Funding Amount Administrative Papa Ola Lokahi $1,854,631 System Ho'ola Lahui Hawaii, and any health care systems certified by POL serving the islands of Kaua'i and Ni'ihau

$3,067,651

System Ke Ola Mamo, and any health care systems certified by POL, serving the island of O'ahu

$3,149,120

System Na Pu'uwai, and any health care systems certified by POL, serving the islands of Moloka'i and Lana'i

$2,561,902

System Hui No Ke Ola Pono, and any health care systems certified by POL, serving the island of Maui

$3,331,410

System Hui Malama Ola Ha'Oiwi, and any health care systems certified by POL, serving the island of Hawaii

$3,034,982

TOTAL $16,999,696

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

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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III. Eligibility Information

1. Eligible Applicants

This Congressional Special Initiative is a limited competition program notice. To be eligible for NHHCIA funding, you must be either:

• A current NHHCIA award recipient named in Table 1, or,

• A new NHHCS applicant certified by POL and serving an island community, or multiple island communities, as specified in Table 1. You must provide proof of certification in Attachment 13 or your application will be considered non-responsive and will not be considered for funding.

2. Cost Sharing/Matching

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

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

3. Other

HRSA will consider any application that exceeds the maximum funding amount listed in Table 1 non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that does not include the Project Narrative 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 non-responsive and will not consider it for funding under this notice.

NOTE: Multiple applications from an organization are not allowable.

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.

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this NOFO (HRSA-21-009), 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 select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

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 SF-424 Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit may not exceed the equivalent of 100 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the SF-424 Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-009, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) will not be counted in the page limit. It is therefore important 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You 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 15: Project Update and Other Relevant Documents.

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

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

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

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

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

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

Narrative or the designated forms and attachments.

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

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

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NATIVE HAWAIIAN HEALTH CARE SYSTEMS (NHHCS): Narrative Instructions

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

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

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

b. Demographic, cultural, and ethnic factors.

c. Unemployment or educational factors.

d. Barriers to accessing health services, including SDOH (e.g., transportation, income level, employment, insurance, education, cultural or language issues, other SDOH, access issues related to managed care or reimbursement, geography or transportation).

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

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

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

b. Service delivery considerations.

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

RESPONSE (Corresponds to Section V’s NHHCS Review Criterion #2) The Response should address services to be provided and program activities that will occur over the 3-year period of performance of August 1, 2021 to July 31, 2024.

1) Describe the services and activities planned to address the needs of the target population and meet the requirements outlined in the authorizing legislation. Using the services listed in Appendix A, describe how you will provide all required services, and any proposed optional additional services.

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

3) Describe how you will ensure that delivery of proposed activities will be initiated within 60 days of award. Provide a timeline for hiring, onboarding, and development of staff, as needed.

4) Describe continuous quality improvement/quality assurance plans and activities relevant to the proposed project to improve health status and advance health equity.

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COLLABORATION (Corresponds to Section V’s NHHCS Review Criterion #3)

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

2) Describe collaboration with POL to carry out the mission of the NHHCIA. Include a copy of any formal agreement as part of Attachment 15: Project Update and Other Relevant Documents.

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

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

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

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

RESOURCES/CAPABILITIES (Corresponds to Section V’s NHHCS Review Criterion #5)

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

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

3) Describe your corporate compliance competencies, including financial and operational oversight, and review and update of malpractice and other insurances.

4) Describe your data analysis and data reporting capability required to meet the Funding Requirements.

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

6) Describe any issues identified by POL during your certification process and how you addressed them. New system applicants MUST upload their signed certification certificate from POL as Attachment 13 in the application.

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

8) Describe your revenues and collection activities, including self-pay income, third-party reimbursement, and sliding-fee schedule collections, consistent with Attachment 6.

Describe the organization’s fiscal status and plans for maintaining long-term financial viability, including establishment or maintenance of the required Medicaid reimbursement arrangement.1

SUPPORT REQUESTED (Corresponds to Section V’s NHHCS Review Criterion #6)

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

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

2) Demonstrate how funds will not be duplicative of existing resources.

3) Describe plans to:

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

b. Adhere to the 10 percent administrative cap.

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

PAPA OLA LOKAHI (POL): Narrative Instructions

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

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

2) Describe the need for, and barriers to, collecting data associated with the unique health equity, health status and treatment needs of Native Hawaiians, including aggregate data related to the services provided by the NHHCS. Include any unique population specific health care data needs or characteristics that affect health status (e.g., language or cultural barriers, access issues related to managed care, reimbursement, or geography). Describe how these barriers impact SDOH.

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

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

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4) Describe the need for, and barriers to, coordinating, implementing, and updating a

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

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

The Response should address services to be provided and program activities that will occur over the 3-year period of performance of August 1, 2021 to July 31, 2024.

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

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

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

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

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

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

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

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

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

3) Describe how the full universe of NHHCS – including both existing and new organizations – will be planned, recognized, and certified over the course of the period of performance such that multiple qualified NHHCS may be positioned to serve one or more of the identified island communities in FY 2024. Include your current recognition and certification procedure as Attachment 14, and describe how the planning, recognition, and certification processes have been and will continue to be publicized to the island communities.

4) Outline a plan to assure that all newly proposed activities will be initiated within 60 days of award.

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

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

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2) Describe your efforts to collaborate with other medical providers or federally-funded entities (as applicable) to carry out the mission of the NHHCIA. These may include but are not limited to: HRSA-funded health centers (including look-alikes), NHHCS, local hospitals, state and local health services delivery organizations, specialty providers, and social service organizations. Include a copy of any formal agreements as part of Attachment 15: Project Update and Other Relevant Documents.

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

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

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

RESOURCES/CAPABILITIES (Corresponds to Section V’s POL Review Criterion #5)

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

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

3) Describe how your governing board, listed in Attachment 10, complies with the legislation (see Governance), including representation from each NHHCS (as listed in Table 1), and how it monitors and evaluates your organization’s operational and financial performance.

4) Describe your fiscal management and management information systems (MIS)

5) Describe your fiscal status and plans for maintaining long-term financial viability.

6) Describe your data analysis and data reporting capability, as required to meet the Funding Requirements.

SUPPORT REQUESTED (Corresponds to Section V’s POL Review Criterion #6)

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

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

2) Demonstrate that funds will not be duplicative of existing resources.

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To ensure that you fully address the Review Criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Any forms or attachments referenced in a narrative section of a systems application may be considered during an objective review.

Narrative Section, Forms, and Attachments Review Criteria Need section of the Project Narrative (1) Need Response section of the Project Narrative Attachment 1: Project Work Plan* Attachment 12: Summary of Contracts and Agreements Attachment 14: Formal Certification Procedure* Required and Optional Additional Services**

(2) Response

Collaboration section of the Project Narrative Attachment 11: Letters of Support Attachment 15: Project Update and Other Relevant Documents

(3) Collaboration

Evaluative Measures section of the Project Narrative Attachment 2: Required Service Projections** Attachment 3: Required Clinical Performance** Measures Attachment 4: Optional Clinical Performance** Measures Attachment 5: Required Financial Performance** Measures

(4) Evaluative Measures

Resources/Capabilities section of the Project Narrative Attachment 6: Income Analysis Form** Attachment 7: Staffing Plan Attachment 8: Position Descriptions for Key Personnel Attachment 9: Biographical Sketches for Key Personnel Attachment 10: Current Board Member Characteristics Attachment 13: Certification from POL**

(5) Resources/ Capabilities

Support Requested section of the Project Narrative

SF-424A

Budget Narrative

(6) Support Requested

*Item only applies to POL.

**Item only applies to NHHCS.

iii. Budget The directions offered in the SF-424 Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application Guide and the additional budget instructions provided below. A budget that follows the SF-424 Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

While the NHHCIA period of performance is for 3 years, the funding will be awarded http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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annually subject to progress and federal appropriations. As such, provide budget and budget justification information for the first year (as listed in Table 1) of the 3-year period of performance.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and costs borne by you to satisfy a matching requirement, as applicable.

In addition, the NHHCIA program requires the following:

STANDARD FORM 424A:

Complete Sections A, B, C, E, and F of the SF-424A Budget Information – Non- Construction Programs. The budget must be prepared for the requested first 12-month period (August 1, 2021 – July 31, 2022) as listed in Table 1. All budget amounts must be rounded to the nearest whole dollar.

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

SECTION A – BUDGET SUMMARY

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

SECTION B – BUDGET CATEGORIES

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

SECTION C – NON-FEDERAL RESOURCES

Enter the non-federal resources. NHHCS applicants are required to include non-federal matching funds in an amount equal to $1 for every $5 of federal funds. See Cost Sharing/Matching for guidance.

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

PROJECT

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

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SECTION F – OTHER BUDGET INFORMATION (ONLY IF APPLICABLE)

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

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

Line 23: Provide other explanation as necessary.

The Further Consolidated Appropriations Act, 2020 (P.L.116-94), Division A, § 202 states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” See Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 Application Guide for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

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

In addition, the NHHCIA program requires a detailed budget narrative in line-item format corresponding with Section B of the SF-424A for the first 12-month period (August 1, 2021 – July 31, 2022) as listed in Table 1.

Provide the following information in the budget narrative:

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

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

• For NHHCS only: A detailed presentation of the breakdown and sources for matching funds as required in 42 U.S.C. § 11705(e).

• For NHHCS only: A demonstration of adherence to the 10 percent administrative cap.

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

v. Attachments Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Indirect cost rate agreements and proof of non-profit status (if applicable) will not count toward the page limit. Clearly label each attachment.

Attachment 1: Project Work Plan (Required for POL)

Upload the Project Work Plan for the 3-year period of performance. Refer to the Response section for details on the required elements. A sample is available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

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

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Attachment 2: Required Service Projections (Required for NHHCS)

Upload the Required Service Projections form (see Table 2). Refer to Appendix B for detailed instructions. A sample is available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

Attachment 3: Required Clinical Performance Measures (Required for NHHCS) Upload the Required Clinical Performance Measures forms (see Table 3). Refer to Appendix B for detailed instructions. Required forms are available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

Attachment 4: Optional Clinical Performance Measures (Optional for NHHCS) Upload the Optional Clinical Performance Measures form, as desired (see Table 4).

Refer to Appendix B for detailed instructions. Required forms are available at

Attachment 5: Required Financial Performance Measures (Required for NHHCS)

Upload the Required Financial Performance Measures form (see Table 5). Refer to Appendix B for detailed instructions. Required forms are available at

Attachment 6: Income Analysis Form (Required for NHHCS)

Upload the Income Analysis Form. Refer to Appendix C for detailed instructions. The required form is available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

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

Upload a staffing plan table that provides a justification for each staff member, including education and experience qualifications, and a rationale for the amount of time being requested for each staff position to be supported under the grant. A sample and instructions are available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

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

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

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

Attachment 9: Biographical Sketches for Key Personnel (Required for NHHCS and POL) Upload biographical sketches for key personnel only, including CEO, CFO, COO, CMO, and PD. Biographical sketches should not exceed one page each. When applicable, biographical sketches should include training, language fluency, and https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/NHHCS/

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experience working with the cultural and linguistically diverse populations to be served, as applicable.

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

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

Upload the form, including office held, area of expertise, and years of continuous Board service. Required forms are available at https://bphc.hrsa.gov/program-opportunities/nhhcs.

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

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

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

• Name and contract information for each affiliated agency;

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

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

• Timeframe for each agreement/contract/affiliation.

Attachment 13: Certification from POL (Required for NHHCS)

Upload your current NHHCS certification from POL.

Attachment 14: Formal Certification Procedure (Required for POL)

Upload your current certification procedure used to certify service delivery organizations as NHHCS.

Attachment 15: Project Update and Other Relevant Documents (as applicable)

Upload your Project Update (required if you are a current NHHCIA award recipient;

refer to Appendix D for detailed instructions) and your indirect cost rate agreement, if applicable. Also, NHHCS must upload a copy of any formal agreement with POL that documents collaboration to carry out the mission of the NHHCIA. Include any other relevant documents to support your proposed project, as desired.

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

Transition to the Unique Entity Identifier (UEI) and System for Award Management (SAM)

You must obtain a valid DUNS number, also known as the Unique Entity Identifier (UEI), and provide that number in the application. In April 2022, the DUNS number will be replaced by the UEI, a “new, non-proprietary identifier” requested in, and assigned by, the System for Award Management (SAM.gov). For more details, visit the following pages:

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Planned UEI Updates in Grant Application Forms and General Service Administration’s UEI Update.

You must also register with SAM and continue to maintain active SAM registration with current information at all times…