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FAQ: Integrated Maternal Health Services Program

Funding Opportunity Number: HRSA-23-106

Estimated Number and Type of Award(s): HRSA expects to fund up to five awards in the form of cooperative agreements.

Estimated Annual Award Amount? Each award will be funded up to $1,800,000 per year during the five-year project period.

When is the application due? Tuesday, May 24, 2023, at 11:59 p.m. ET.

Eligibility and award

What are the eligibility requirements?
Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply. This includes State and local departments of health, foundations, and community-based organizations. (NOFO pg. i)
Are nonprofit organizations (e.g. 501c3’s) eligible to apply for this funding opportunity?
Yes, non-profit 501(c)(3) organizations are eligible to apply for funding under this opportunity. The IRS classifies 501(c)(3) organizations as either a private foundation or public charity. (NOFO pg. ii and 6).
Does a safety net health center, funded by a state special health care district, qualify as a "state agency"?
A state agency is defined as a permanent or semi-permanent organization within a state government that is responsible for the oversight and administration of specific functions. Regardless of the type of entity, any domestic public or private entity, including an Indian Tribe or Tribal Organization, is eligible to apply for the Integrated Maternal Health Services demonstration award.
Can we apply for Alliance for Innovation on Maternal Health (AIM) Capacity grant and the Integrated Maternal Health Services cooperative agreement?

Yes, if your organization meets the eligibility requirements for both programs, you are eligible to apply for both opportunities. The AIM Capacity Program and the Integrated Maternal Health Services Program are part of HRSA’s effort to address maternal mortality and severe maternal morbidity. Please review the eligibility and project narrative sections for each program carefully.

Please note that the program requirements for each of these programs are different, and your application needs to respond to the program requirements of the NOFO to which you are applying. HRSA encourages you to read the Purpose and Program Requirements and Expectations sections of both notices of funding opportunity. If your organization meets the eligibility requirements and the organization can meet the requirements and expectations of both funding opportunities, you may choose to apply for both funding opportunities.

Organizational capacity and staffing

Who counts as key personnel?
HRSA defines key personnel as individuals who are considered critical to the project, and their removal or absence from the project would have a significant impact on the approved project. This includes but not limited to principal investigator/program director, epidemiologist/evaluator and staff who oversees the budget.
Does the organization who apply for the grants need to hire physicians and nurses to provide the care?

The recipients of this award are responsible for establishing a diverse workforce reflective of populations served, which may include but is not limited to, racial and ethnic diversity as stated on page 10 of the NOFO.

The recipient is expected to:

  • Recruit maternal health care practitioners (e.g., obstetrics, family practice, certified nurse midwives) and workers to deliver pregnancy care management and care coordination (e.g., nurses, social workers, community health workers, doulas) to implement the integrated model serving pregnant and postpartum people with health disparities and limited access to basic social and health care services.
  • Train OB providers and workers that include culturally and linguistically appropriate services, trauma-informed care, implicit bias, motivational interviewing, and social determinants of health.
How involved do you suggest medical personnel to be included in the project? Would it be suggested to include OB-GYNs in the personnel team?
IMHS recipients are expected to work with relevant stakeholders to develop and carry out an proposed IMHS model for the demonstration. A recipient may choose to include OB-GYNs in the personnel team based on their model. Recipients are expected to include staff with experience, skills and knowledge of integrated health services models. Staff are also expected to provide leadership in supporting workforce development for direct service providers in maternal health.
Does HRSA think that an OB clinical provider or health department should be the lead applicant/IMHS team leader, or could a non-clinical community provider feasibly lead the cooperative agreement?
HRSA does not specify the title, position, or degree of the IMHS team lead. IMHS recipients are expected to hire personnel who are qualified by training and/or experience to manage, implement, and carry out the proposed demonstration.

Program implementation

Will this funding opportunity pay for prescriptions such as LARC?
Please review page 9 of the NOFO explaining the parameters of the Integrated Maternal Health Services program. As stated in the NOFO, “If the design of your integrated health services model includes incentivizing providers and health care systems to support comprehensive maternal health care, you should consider partnering with your state Medicaid program, if feasible.” HRSA does not preclude an applicant from allocating funds to pay for prescriptions such as for LARC coverage as an incentive. In your application, please provide a detailed budget and budget narrative explaining how much funds you will allocate to pay for prescriptions such as LARC and include a description within the application narrative for any need to cover prescription costs, and the organizations, if any, you will collaborate and partner with to support prescription costs.
Can you define region? Can we apply and focus on one major city in the state? Or should our proposal include multiple cities? Does a region have to include counties?
HRSA does not define the region to be targeted for his NOFO. To apply for funding, you must be implemented in State, jurisdiction, territory or tribal community level. As such your region may be comprised of multiple cities or counties that share boundaries or same geographical characteristics. Please note that HRSA will not fund more than one cooperative agreement within a state.
Can you elaborate on Letters of Support/ Agreements, are there a minimum number required?
HRSA does not require a minimum or a maximum number of letters of support. Applicants are encouraged to provide evidence of collaborative relationships with State Medicaid agencies and State-level or county-level Departments of Health. Reviewers will consider letters of support in the scoring of applications. Applicants should note that the letter of support will count toward the 50-page limit.
Are these funds only for the development and implementation of a new program or can they be used to enhance existing programming?
IMHS funds should not be used to supplant existing funds. However, an applicant may choose to submit an application that builds upon existing strategies to foster the development and demonstrations of integrated health services models which support the population with the greatest unmet needs in the state.
Is there a target number of beneficiaries over the five-year cooperative agreement?

HRSA does not specify a target number of beneficiaries. However, HRSA specifically outlines the objectives that IMHS recipients must accomplish over the five-year project period.

They include the following:

  • Implement a model that includes all core strategies and activities
  • Report data for key measures by race and ethnicity
  • Incorporate strategies that deliberately address disparities

Please review page 2 of the NOFO for the complete list of program objectives.

Does the data sharing agreement with the state, for those applying who are not state agency, need to be executed prior to applying for funding or can it be in the legislative process/in process of being executed?
HRSA does not require the data sharing agreement to be fully executed prior to applying for the Integrated Maternal Health Services demonstration. However, the applicant should provide any documentation to confirm pending agreement. The documentation should also clearly describe the roles and responsibilities of all the parties. The letters of agreement should be signed and dated. Grant reviewers will consider the level and degree of commitment and/or progress in the execution of data sharing agreements as part of the review and scoring process.
We are a program currently collaborating with clinics in OB deserts across three counties. Our current existing program would expand to work with other OB deserts in the state. Does this conflict with the requirement of non-duplication of services?
Program expansion does not constitute a duplication of services. However, the recipient should ensure that the expansion will support the increase of access to quality, equitable, comprehensive care for pregnant and postpartum people who experience health disparities, and who have limited access to basic social and health care services.
Does the NOFO allow for establishing a model in one smaller region, then expanding to another region? Would we be at disadvantage if we are only focusing on a smaller region?
Recipients of this program may consider developing Integrated Maternal Health Service models throughout the state that support comprehensive care for pregnant and postpartum people. While a recipient may start with a small region, HRSA expects the recipients to establish the Integrated Model Health Services demonstration that supports the population with the greatest unmet maternal health needs.
If there are team members from the same organization (Org A) who work in different departments on different projects would the second (Org A) submission cancel out the first?
Applicants must note that HRSA will only accept one submission per organization, and as such, the last uploaded application will cancel any previous submissions. However, it is allowable for an organization serve as a participating agency on more than one application, provided that organization is not the “applicant” on more than one application.


Are we able to request a lower Indirect Cost Rate than our negotiated rate in order to use more grant funds for direct costs?
A recipient can request a lower indirect cost rate than they are approved for in their negotiated indirect cost rate agreement.
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