v2.MODIFIED 4.5.23_FORHP HRSA-23-125 (D78) Rural Health Care Coordination.FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Federal Office of Rural Health Policy Community-Based Division

Rural Health Care Coordination Program

Funding Opportunity Number: HRSA-23-125

Funding Opportunity Type: New

Assistance Listings Number: 93.912

Application Due Date: May 26, 2023 MODIFIED on April 5, 2023:

Revision: Extended the Application Due Date.

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 may take up to 1 month to complete.

Issuance Date: March 23, 2023

Amber Berrian Public Health Analyst Federal Office of Rural Health Policy Telephone: (301) 443-0845 Email: forhprhccp@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. 254c(e) (Section 330A(e) of the Public Health Service Act) mailto:forhprhccp@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access the information in this file. For assistance, email or call one of the HRSA staff listed in Section VII. Agency Contacts.

EXECUTIVE SUMMARY

Funding Opportunity Title: Rural Health Care Coordination Program Funding Opportunity Number: HRSA-23-125 Assistance Listing Number: 93.912 Due Date for Applications: May 26, 2023 Purpose: The purpose of this program is to promote rural health care services outreach by improving and expanding delivery of health care services through the application of care coordination strategies in rural areas.

Program Goal(s): The goals of the Rural Health Care Coordination Program are to:

1. Expand access to and quality of equitable health care services through care coordination strategies exclusively in rural areas;

2. Utilize an innovative evidence-based, promising practice, and/or value-based care model(s) known or demonstrate strong evidence to improve patient health outcomes, and the planning and delivery of patient-centered health care services;

3. Increase collaboration among multi-sector and multidisciplinary network partnerships to address the underlying factors related to social determinants of health; and

4. Develop deliberate and sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems.

Eligible Applicants: To be eligible to receive a grant under this program, an entity shall:

(A) Be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;

(B) Represent a consortium (see Appendix B) composed of members that include 3 or more

HRSA-23-125 iii HRSA-23-125 iii health care providers and may be nonprofit or for-profit entities, including tribes and tribal organizations; and

(C) Not previously received a grant under 42 U.S.C.

254c(e) for the same or similar project unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

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

Anticipated Total Annual Available FY 2023 Funding:

$3,000,000

Estimated Number and Type of Award(s):

Up to 10 grants

Estimated Annual Award Amount: Up to $300,000 per award Cost Sharing/Match Required: No Estimated Notice of Award Date: September 1, 2023 Period of Performance: September 1, 2023, through August 31, 2027 (4 years) Who to contact for questions: For overall Program questions/technical assistance:

Amber Berrian Public Health Analyst Community Based Division Federal Office of Rural Health Policy Email: aberrian@hrsa.gov Telephone: 301-443-0845

For information regarding business, administrative or fiscal issues:

Eric Brown Grants Management Specialist Division of Grants Management Operations Office of Federal Assistance Management Email: ebrown@hrsa.gov Phone: 301-945-9844 mailto:aberrian@hrsa.gov mailto:ebrown@hrsa.gov

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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, except where instructed in this NOFO to do otherwise. Visit HRSA’s How to Prepare Your Application page at https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your- application for more information.

Technical Assistance HRSA has scheduled a pre-application technical assistance webinar:

April 6, 2023 Time: 3 – 4 p.m. ET Weblink:

https://hrsa-gov.zoomgov.com/j/1610629141?pwd=TGtJVGNZVjB6T1RTZlB5U0dTRWltUT09

Attendees without computer access or computer audio can use the dial-in information below:

Call-In Number: 1-833-568-8864 Participant Code: 32032979

The webinar will provide an overview of the NOFO and an opportunity for you to ask questions.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1610629141?pwd=TGtJVGNZVjB6T1RTZlB5U0dTRWltUT09

Table of Contents

I. Program Description ____________________________________________________ 1

1. Purpose ____________________________________________________________ 1

2. Background ________________________________________________________ 2

II. Award Information ______________________________________________________ 4

1. Type of Application and Award ________________________________________ 4

2. Summary of Funding _________________________________________________ 4

III. Eligibility Information __________________________________________________ 5

1. Eligible Applicants ___________________________________________________ 5

2. Cost-Sharing/Matching _______________________________________________ 5

3. Other ______________________________________________________________ 5

IV. Application and Submission Information __________________________________ 7

1. Address to Request Application Package ________________________________ 7

2. Content and Form of Application Submission ____________________________ 8

3. Unique Entity Identifier (UEI) and System for Award Management (SAM) _____ 23

4. Submission Dates and Times _________________________________________ 24

5. Intergovernmental Review ___________________________________________ 24

6. Funding Restrictions ________________________________________________ 24

V. Application Review Information __________________________________________ 25

1. Review Criteria _____________________________________________________ 25

2. Review and Selection Process ________________________________________ 34

3. Assessment of Risk _________________________________________________ 35

VI. Award Administration Information ______________________________________ 36

1. Award Notices _____________________________________________________ 36

2. Administrative and National Policy Requirements ________________________ 36

3. Reporting _________________________________________________________ 37

VII. Agency Contacts _____________________________________________________ 39 VIII. Other Information ____________________________________________________ 40 Appendix A: Draft Performance Measures _____________________________________ 42 Appendix B: Definitions ____________________________________________________ 45 Appendix C: Page Limit Worksheet ___________________________________________ 50

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I. Program Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Health Care Coordination Program. The purpose of this program is to promote rural health care services outreach by improving and expanding delivery of health care services through comprehensive care coordination strategies in rural areas. This award is intended to serve as initial seed funding to implement creative community-based health solutions in rural communities to expand access to and coordination of care with the expectation that awardees will then be able to sustain the program after the federal funding ends.

The goals for the Rural Health Care Coordination Program are to:

1. Expand access to and quality of equitable health care services through care coordination strategies exclusively in rural areas;

2. Utilize an innovative evidence-based, promising practice, and/or value-based care model(s) that is known to, or demonstrates strong evidence to, improve patient health outcomes and the planning and delivery of patient-centered health care services;

3. Increase collaboration among multi-sector and multidisciplinary network partnerships to address the underlying factors related to social determinants of health; and

4. Develop and implement deliberate and sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems.

The Rural Health Care Coordination Program is a four-year program with year one (September 1, 2023 – August 31, 2024) being a planning year and years two – four (September 1, 2024 – August 31, 2027) focused on program implementation.

Applicants are required to select one primary focus area from the following: 1) heart disease; 2) cancer; 3) chronic lower respiratory disease; 4) stroke; or 5) maternal health. Applicants are to propose innovative approaches to achieve the program goals, address local health challenges including the underlying risk factors that contribute to the selected primary focus area, and improve population health outcomes through coordinated, community-wide programs that link health and human services within an established or formal network (for the purposes of this program the terms “consortium” and “network” are used interchangeably). Although it is required to select one primary focus area, applicants may include underlying risk factors that contribute to the selected primary focus area understanding care coordination includes the provision of care for individuals with chronic and/or medically complex diseases.

At the end of the four years, applicants should be able to contribute to the following outcomes:

1. Expanded access to and affordability of quality comprehensive care coordination leading to cost savings and overall health improvement status;

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2. Improved patient health outcomes through the utilization of chronic care management, and/or preventive and wellness services;

3. Institutionalized care coordination strategies within their policies, procedures, staffing, services, and communication systems;

4. Implemented a multidisciplinary and multi-sector referral system; and

5. Identified a variety of funding and financing mechanisms to continue comprehensive care coordination strategies beyond the initial FORHP grant funding.

For more details, see Program-Specific Instructions.

2. Background

The Rural Health Care Coordination Program is authorized by 42 U.S.C. 254c(e) (Section 330A(e) of the Public Health Service Act) to promote rural health care services outreach by improving and expanding delivery of health care services through comprehensive care coordination strategies addressing a primary focus area: 1) heart disease; 2) cancer; 3) chronic lower respiratory disease; 4) stroke; or 5) maternal health.

Care coordination is a vital aspect of health and healthcare services particularly for individuals with chronic or medically complex conditions. For this program, care coordination is “the deliberate organization of a patient’s care to facilitate the appropriate delivery of health care services”.1 Care coordination connects primary care physicians, specialists, hospitals, behavioral health providers, other health care organizations, and non-health social service organizations, including but not limited to schools, housing agencies, correctional facilities, and transportation organizations.

When care is poorly coordinated in addition to inappropriate follow-up care, patients who see multiple physicians and care providers can face medication errors, hospital readmissions, and avoidable emergency department visits.2 The effects of poorly coordinated care are particularly evident for people with chronic conditions, such as hypertension, chronic lower respiratory disease and those at high risk for multiple illnesses such as cancer or perinatal related complications. As a result, patients are often expected to navigate a complex healthcare system. Chronic disease is a contributing factor to the five leading causes of death nationally.3 Therefore, when a network of health care and non-health social services organizations work together to plan, deliver, communicate information, and organize a patient’s care to ensure safe, appropriate, and effective care, it creates smooth transitions allowing for holistic patient care and patient engagement in care management.4

Rural communities face unique circumstances that pose increased challenges to patient care and well-being. Rural residents tend to be older, in poorer health, and more likely to smoke, be obese, sedentary, and tend to be poorer and have less formal

1 https://www.ahrq.gov/ncepcr/care/coordination.html 2 RWJF_SHVS_Realizing-Rural-Care-Coordination.pdf 3 Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties — United States, 2010–2017 | MMWR (cdc.gov) 4 RWJF_SHVS_Realizing-Rural-Care-Coordination.pdf https://www.ahrq.gov/ncepcr/care/coordination.html https://www.shvs.org/wp-content/uploads/2014/04/RWJF_SHVS_Realizing-Rural-Care-Coordination.pdf https://www.cdc.gov/mmwr/volumes/68/ss/ss6810a1.htm?s_cid=ss6810a1_w https://www.cdc.gov/mmwr/volumes/68/ss/ss6810a1.htm?s_cid=ss6810a1_w https://www.shvs.org/wp-content/uploads/2014/04/RWJF_SHVS_Realizing-Rural-Care-Coordination.pdf

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education than their urban counterparts.5 Rural infrastructure such as access to transportation can be limited and pose challenges. The clinical infrastructure in many rural areas is limited, with a focus on primary care and chronic disease management and less access to specialty care. Care coordination is a deliberate and planned approach, providing opportunities to facilitate patient-centered care integration, effectively utilize scarce rural resources, and improve clinical quality through a community-based network approach.

Implementing the provision of equitable care coordination strategies is particularly important to address geographic, gender, and race-based disparities within rural communities. The National Heart, Lung, and Blood Institute (NHLBI) recently published a study demonstrating that rural populations experience an increased burden of heart failure mortality compared with urban populations, and Black men living in rural areas have an especially higher risk.6 Heart failure is a chronic and progressive condition that develops when the heart does not pump enough blood for the body’s needs and can lead to multiple chronic and complex conditions for individuals. Heart failure, like most other cardiovascular diseases (CVD), can be prevented by following a heart-healthy lifestyle or seeking treatment to manage CVD. The study underscores the importance of developing customized approaches to heart failure prevention and other cardiovascular diseases among rural residents, particularly Black men. Additionally, rural populations persistently experience cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination.7

The Cancer Moonshot Initiative calls on a multi-sector and multi-disciplinary collaboration of private and non-profit sectors, academic institutions and health care providers to close cancer screening gaps, tackle environmental exposures, decrease preventable cancers, and promote advanced research, all while supporting patients and caregivers.

Care coordination is crucial across all aspects of health and health care. An emergent priority addressed through care coordination is the improvement of maternal health outcomes, especially in rural areas. National trends in maternal health have worsened over time, distinctly noting the rural and urban differences for maternal morbidity and mortality rates show rural residents have a 9 percent greater chance of experiencing severe maternal morbidity and mortality compared with urban residents.8

Applicants should consider throughout implementation how they can leverage expanded Medicare codes that support integration of behavioral health and primary care, chronic care management, and other care management strategies that could be a key part of sustaining this program.9 10 Similarly, applicants may want to consider participation in the Medicare Shared Savings Program (MSSP) as another potential sustainability strategy. The purpose of the MSSP is to support the formation of Accountable Care Organizations (ACOs) and pay these groups of doctors, hospitals, 5 "Overview of Rural Health" by Vincent Francisco, Craig Ravesloot Ph.D. et al. (umt.edu) 6 Risk of developing heart failure much higher in U.S. adults living in rural areas vs urban | NHLBI, NIH 7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8997116/ 8 https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america 9 MLN909188 – Chronic Care Management (cms.gov) 10 Care Management Medicare Reimbursement Strategies for Rural Providers (ruralhealthinfo.org) https://www.whitehouse.gov/cancermoonshot/ https://scholarworks.umt.edu/ruralinst_independent_living_community_participation/40/ https://www.nhlbi.nih.gov/news/2023/risk-developing-heart-failure-much-higher-us-adults-living-rural-areas-vs-urban https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8997116/ https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf https://www.ruralhealthinfo.org/care-management

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and other health care providers to furnish coordinated, high-quality care to people with Medicare.11 Applicants may also consider if their approach aligns with new flexibilities under the MSSP designed to support greater participation of ACOs serving rural and underserved Medicare beneficiaries. These new flexibilities include opportunities for upfront payments and a smoother transition to performance-based risk in the MSSP.

The new upfront payments in the MSSP may make it easier to form new ACOs, and ACOs may use these funds for a number of purposes including increasing staffing and addressing the social determinants of health (e.g., hiring community health workers, partnering with community-based organizations to address SDOH needs, implementing systems to provide and track patient referrals to available community-based social services).1213 Applicants should consider other state-based, national, and private sector value-based efforts that also could be leveraged for sustainability of care coordination efforts beyond this grant. Care coordination initiatives made possible by this grant can be an opportunity not only to improve health outcomes, but also generate cost-savings for both public and private payers.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $3,000,000 to be available annually to fund 10 recipients. You may apply for a ceiling amount of up to $300,000 annually (reflecting direct and indirect costs) per year.

The period of performance is September 1, 2023, through August 31, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for the Rural Health Care Coordination Program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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

11 Medicare Shared Savings Program Saves Medicare More Than $1.6 Billion in 2021 and Continues to Deliver High-quality Care | HHS.gov 12 https://www.federalregister.gov/documents/2022/07/29/2022-14562/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other 13 Federal Register :: Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs To Provide Refunds With Respect to Discarded Amounts; and COVID-19 Interim Final Rules https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.hhs.gov/about/news/2022/08/30/medicare-shared-savings-program-saves-medicare-more-than-1-6-billion-in-2021-and-continues-to-deliver-high-quality-care.html https://www.hhs.gov/about/news/2022/08/30/medicare-shared-savings-program-saves-medicare-more-than-1-6-billion-in-2021-and-continues-to-deliver-high-quality-care.html https://www.federalregister.gov/documents/2022/07/29/2022-14562/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other https://www.federalregister.gov/documents/2022/07/29/2022-14562/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other https://www.federalregister.gov/documents/2022/11/18/2022-23873/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other https://www.federalregister.gov/documents/2022/11/18/2022-23873/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other https://www.federalregister.gov/documents/2022/11/18/2022-23873/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other https://www.federalregister.gov/documents/2022/11/18/2022-23873/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public or private, non-profit or for-profit entities, including faith-based, community-based, tribes, and tribal organizations. The applicant organization may be located in a rural or urban area, but must have demonstrated experience serving, or the capacity to serve, rural underserved populations. The applicant organization should describe in detail their experience and/or capacity to serve rural populations in the Project Abstract section of the application.

The applicant organization must represent a network composed of members that include three or more health care providers. For the purposes of this funding opportunity, the terms “consortium” and “network” are used interchangeably. The applicant organization may not previously have received an award under 42 U.S.C.

254c(e) from the HRSA Federal Office of Rural Health Policy for the same or a similar project unless the applicant is proposing to expand the scope of the project or the area that will be served through the project.

For more details, see Program Requirements and Expectations.

2. Cost-Sharing/Matching

Cost-sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Multiple Applications

Multiple applications from an organization with the same Unique Entity Identifier (UEI) are not allowable.

NOTE: Applications associated with the same DUNS number or EIN should be independently developed and written. HRSA reserves the right to deem applications that provide insufficient information in Attachment 5 or are nearly identical in content, to be ineligible. In this instance, assuming all other eligibility criteria are met, 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.

https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update

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HRSA will only accept your last validated electronic submission before the Grants.gov application due date as the final and only acceptable application.

Requesting Exceptions

Tribal exception: HRSA is aware that tribes and tribal governments may have an established infrastructure without separation of services recognized by filing for EINs. In case of tribes and tribal governments, only a single EIN located in a HRSA-designated rural area is necessary to meet the network requirements. Tribes and tribal entities under the same tribal governance must still meet the network criteria of three or more entities committed to the proposed approach, as evidenced by a signed letter of commitment that delineates the expertise, roles and responsibilities in the project, and commitments of each network member. Please submit this information, as Attachment 5.

Multiple EIN exception: In general, multiple applications associated with the same DUNS number and/or EIN are not allowable. However, HRSA recognizes a growing trend towards greater consolidation within the health care industry and the possibility that health care organizations may share the same EIN as its parent organization. As a result, at HRSA’s discretion, multiple health care organizations that share the same EIN as its parent organization or, organizations within the same network who are proposing different projects are eligible to apply by requesting an exception. Please submit this information, as Attachment 5.

To request for a Tribal Exception and/or Multiple EIN Exception, the following must be included in Attachment 5:

• Names, titles, email addresses, and phone numbers for points of contact at each of the applicant organizations and the parent organization;

• Proposed project focus and service area for each applicant organization with the same EIN (these should not overlap);

• Justification for why each applicant organization must apply to this funding opportunity separately as the applicant organization, as opposed to serving as network member organizations on other applications;

• Assurance that the applicant organizations will each be responsible for the planning, program management, financial management, and decision making of their respective projects, independent of each other and/or the parent organization; and

• Signatures from the points of contact at each applicant organization and the parent organization.

Consulting your State Office of Rural Health

By statute, all applicants are required to consult their State Office of Rural Health (SORH) or equivalent (appropriate state entity) regarding their intent to apply to this program.

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HRSA strongly recommends applicants contact their SORH before applying. The SORHs have expertise in FORHP programs specifically as well as rural health generally, and there may be opportunities to utilize SORH expertise in ways to that enhances applications. For example, the SORH may be able to provide information regarding model programs, data resources, and technical assistance for networks, evaluation, partner organizations, or support of information dissemination activities. For this program especially, the SORH can play a vital role as a network partner in both the application phase and if awarded, the planning and implementation phases of this program. If you do not receive a response, please include the original letter of intent requesting the consultation.

SORHs responding to this notice as the applicant organization must provide an attestation in Attachment 1 that there is no conflict of interest and other non-SORH applicants were not prejudiced. This attestation must clearly show that the SORH application was independently developed and written and that they have not knowingly duplicated efforts or project ideas of non- SORH applicants within their state.

Each state has a SORH, and a list of the SORHs can be accessed at:

https://nosorh.org/nosorhmembers/nosorh-members-browse-bystate/. All applicants must include in Attachment 1 a copy of the letter or email sent to the SORH, and any response received to the letter, which was submitted to the SORH describing their project.

Applicants located 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, or the Republic of Palau that do not have the functional equivalent of a SORH are nevertheless eligible to apply.

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 Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov: APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-125 in order to receive notifications including modifications, clarifications, and/or republications of the https://nosorh.org/nosorhmembers/nosorh-members-browse-bystate/ https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html

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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

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in HRSA SF-424 Application Guide in addition to the VAP-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 budget figures expressed in U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the HRSA SF-424 Application Guide for the Application Completeness Checklist.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. HRSA will not review any pages that exceed the page limit. Using the pages within the page limit, HRSA will determine eligibility using Section III. Eligibility Information of the NOFO.

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-125 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete and validated by Grants.gov under HRSA-23- 125 before the deadline.

https://www.grants.gov/web/grants/applicants.html

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, 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. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 10-15: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e), which sunsets / terminates on September 30, 2023. Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations

Service Area Requirements A. All services of the project must be provided in a fully rural county or rural census tract. Funding provided through this program must be used for programs that target populations residing in HRSA-designated rural areas.

To determine the rural eligibility, please refer to Rural Health Grants Eligibility Analyzer (hrsa.gov). Applicants must list the rural counties that will be served in their proposed project. Proposed counties should be fully rural, but if counties are partially rural counties, please include the rural census tract(s) in the Project Abstract.

B. The applicant organization and/or network members may be located in an urban or rural area in the 50 U.S. states or in the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated State of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75&se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx https://data.hrsa.gov/tools/rural-health

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Applicant Organizational Requirements A. The applicant organization must:

a. be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;

b. represent a network composed of members that include three or more health care providers and payers, and may be nonprofit or for-profit entities including tribes and tribal organizations; and

c. not previously received a grant under this program for the same or similar project unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

B. The applicant organization must be in an established or formal network of multi-sector and multi-disciplinary partnerships, please see the definition of health care provider organizations, in Appendix B, for examples of types of partnership organizations.

C. The applicant organization will serve as the lead organization for the proposed network. The applicant must have the staffing and infrastructure necessary to oversee program activities and financial management for the award and ensure that the rural underserved populations and/or organizations in the local community or region to be served will be involved in the development and ongoing operations of the project. HRSA requires that all applicants describe the geographic relationship to the proposed rural service population as well as the plans to ensure that rural populations are served. The applicant must have demonstrated experience serving, or the capacity to serve, rural underserved populations, and describe the experience and/or capacity in the Project Abstract.

D. If the applicant organization shares the same EIN as its parent organization or organizations within the same network are proposing different projects, and the applicant is eligible, then the applicant may request an exception in Attachment 5. Please see section 7 below (Multiple EIN exception) for additional details

Network Requirements A. Applicants must represent a network composed of three or more health care provider organizations and payers, including the applicant organization. All applicants should ensure a collaborative network that is representative of the rural underserved populations and/or organizations in the local community or region to be served. HRSA requires at least sixty-six percent (66%), or two-thirds of the network composition involved in the proposed project be located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer.

B. Each network member must demonstrate substantial involvement in the project and contribute significantly to the goals of the project, including how members will share information across the network and plans for shared governance (see Appendix B). At a minimum, Letters of Support from all network members must be submitted as Attachment 4. If

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awarded, the roles and responsibilities, member engagement, communication processes details of each network member must be clearly defined in a Memorandum of Understanding/Agreement (MOU/A). The MOU/A must be signed by all network members. MOU/As for each network member will be required within six (6) months from the program start date if not submitted at the time of application.

• Formal Network: A network organization is considered formal if the network has a signed Memorandum of Agreement (MOA), Memorandum of Understanding (MOU), or other formal collaborative agreements, including signed and dated bylaws. The network has a governing body that includes representation from all network member organizations and ensures that the governing body, rather than an individual network member, will make financial and programmatic decisions. The award recipient will remain responsible for complying with all financial and program requirements of the grant award.

An advisory board that merely provides advice is not considered a governing body. An already existing non-profit board of individuals convened for providing oversight to a single organization is not an appropriate board structure.

The network ensures a joint decision-making model that ensures an equal voice for all network members and includes ongoing transparency related to network decisions, information and data sharing, and budget allocation decisions.

• Established Network: Meets the above definition of a formal network in addition to having a history of working together.

C. The network must have a permanent network director (i.e., network executive director) or have established an interim network director capable of overseeing the network’s administrative, fiscal, and business operations at the time an award is made. HRSA strongly recommends the network director role be 1.0 FTE and that the project director role is at least 0.5 FTE. HRSA prefers that the network director role is different from the project director.

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

Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

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

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ABSTRACT HEADING CONTENT

Applicant Organization Information Organization Name, Address (street, city, state, zip code), Facility/Entity Type (FHQC, RHC, public health department, etc.) and Website Address (if applicable) Designated Project Director & Network Director Information

- Project Director Name & Title, Contact Phone Number(s), and E-Mail Address

- Network Director Name & Title, Contact Phone Number(s), and E-mail Address

- Key Staff Names & Titles, Contact Phone Number(s), and E-mail Address

Rural Health Care Coordination Project:

Project Title and Goal Primary Focus Area:

Select one primary focus area from the following: 1) heart disease, 2) cancer, 3) chronic lower respiratory disease, 4) stroke or 5) maternal health) Proposed Service Area(s):

(e.g., states, cities, counties (required)) • NOTE: Proposed rural counties should be fully rural. For partially rural counties, include rural census tract(s).

ABSTRACT BODY CONTENT

Target Patient Population Brief description of the target population group(s) to be served (2-3 sentences max) Network Members

- Network Name, network members’ names, addresses, and EINs

- Total number of member organizations and facility/entity type of organizations;

HRSA requires an attestation that at least sixty-six percent (66%), or two-thirds of the network composition involved in the proposed project be located in a HRSA-designated rural area, as defined by the Rural Health Grants Eligibility Analyzer

Network Project Activities/Services Brief description of the proposed project activities and/or services provided through the network collaboration Expected Outcomes Brief description of the proposed project expected outcomes. Clearly label and organize these expected outcomes by the goals for the Rural Health Care Coordination Program.

Evidence-based, Promising Practice, and/or Value-Based Care Models The title/name of the evidence-based, promising practice, and/or value-based care model(s) that you will be adopting and/or adapting. If the model was tailored for the proposed project, please briefly describe how it was modified.

Capacity to Serve Rural Underserved Populations Applicants must demonstrate their experience serving or the capacity to serve, rural underserved populations. Please describe your capacity to serve rural underserved populations. Examples to show this capacity may include a history or ability to:

- Identify activities that build, strengthen, and maintain the necessary skills and resources needed to sustain or improve health services delivery in rural populations

- Discuss organizational expertise and capacity as it relates to the scope of work proposed. Include a brief overview of the organization’s assets, skills and qualifications to carry on the project

- Describe current experience, including partnerships, activities, program implementation and previous work of a similar nature

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- Discuss the effectiveness of methods and/or activities employed to improve health care services in rural communities

HRSA requires that all applicants describe the geographic relationship to the proposed rural service population as well as the plans to ensure that rural populations are served.

Funding Opportunity Notification Briefly describe how the applicant organization learned about this funding opportunity.

(Select one: State Office of Rural Health, HRSA News Release, Grants.gov, HRSA Project Officer, HRSA Website, Technical Assistance Provider, State/Local Health Department, Other (please explain) Funding Preference Applicants must explicitly document a qualifying funding preference and cite the qualification that is being met (see 42 U.S.C. 254c(h)(3)) to receive a funding preference.

HRSA highly recommends you include concise language making it clear to HRSA which funding preference you qualify for. If you do not qualify for a funding preference, please state that you do not qualify.

If applicable, you need to provide supporting documentation in Attachment 6. Please refer to Section V.2 for further information.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below 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 may be considered during the objective review.

Narrative Section Review Criteria Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response

(3) Evaluative Measures

(4) Impact

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity (3) Evaluative Measures

(4) Impact

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget and Budget Narrative (6) Support Requested

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ii. Project Narrative

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

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

• INTRODUCTION -- Corresponds to Section IV’s Review Criterion_1_Need

Briefly describe the purpose of the proposed project. Briefly summarize the project’s goals and expected outcomes as well as explicitly state the evidence-based, promising practice, systems of care, and/or value-based care model(s) the proposed project will adopt and/or adapt to meet your community’s need.

Briefly describe the modification or innovation from the actual model(s), if applicable, in making it suitable and appropriate for the proposed project.

Utilize evidence-based practices or models to promote successful program implementation. Models can be found at https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based.

• NEED ASSESSMENTS -- Corresponds to Section V’s Review Criterion_1_Need

Provide an overview of the service area and target population to be served.

Outline the needs of the local community or region. Describe the target population and its unmet health needs. Cite demographic data whenever possible to support the information provided.

Use the following sub-headings for this section: Target Population, Disease Burden, Geographic Details of Service Area, Barriers/Challenges, and Health Care Availability in Service Area

1. Target Population - Describe the target population of the proposed project and the associated unmet health needs. The population description may include information about the incidence and prevalence of specific conditions, such as chronic diseases, or regarding age and socioeconomic status of the target population. Additionally, the applicant should demonstrate that the population it proposes to serve includes subpopulations (rural ethnic and racial minorities and/or other vulnerable populations) that have historically suffered from poorer health outcomes, health disparities, and other inequities compared to the rest of the target population. Compare local data to state and federal data where possible.

https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based https://www.ruralhealthinfo.org/project-examples/evidence-levels/evidence-based

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2. Disease Burden - Select a primary focus area for the proposed project: 1) heart disease; 2) cancer; 3) chronic lower respiratory disease; 4) stroke; or

5) maternal health. Describe the burden of disease and/or condition among the target population to be served. Refer to the Purpose for more information on the focus areas and goals of the Rural Health Care Coordination Program. The applicant may include underlying risk factors that contribute to the selected primary focus area understanding care coordination includes the provision of care for individuals with chronic and/or medically complex diseases. The applicant should describe the quality of life for those affected by the disease and/ condition. Data should be used and cited wherever possible to support the information provided.

3. Geographic Details of Service Area – Identify the target service area(s) for the proposed project, using a map. Describe any relevant geographical features of the service area that impact access to health care services.

4. Barriers/Challenges - Identify any relevant key challenges and barriers to the service area, such as geographic, socioeconomic, linguistic, cultural, racial, ethnic, or other barriers, and discuss how the project plans to overcome identified barriers.

5. Health Care Availability in Service Area - Describe the health care services available in or near your target service area, such as the number and types of relevant health and non-health social service organizations, such as housing or transportation agencies and correctional facilities, to…