Integrated Maternal Health Services Initiative

Integrated Maternal Health Services Initiative is sponsored by Health Resources and Services Administration (HRSA). This initiative supports the development and demonstration of integrated maternal health services models to improve clinical services and social supports affecting women's health before, during, and after pregnancy.

U.S. Department of Health and Human Services # NOT ICE OF FUNDING OPPORT UNIT Y # Maternal and Child Health Bureau # Division of Healthy Start and Perinatal Services # Integrated Maternal Health Services # Funding Opportunity Number: HRSA-23-106 # Funding Opportunity Type(s): New # Assistance Listings Number: 93. 110 # Application Due Date: May 24, 2023 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 10, 2023 Lud Abigail Duchatelier-Jeudy, PhD MPH Public Health Analyst, Maternal and Women’s Health Branch Division of Healthy Start and Perinatal Services Maternal and Child Health Bureau Email: wellwomancare@hrsa. gov See Section VII for a complete list of agency contacts. Authority: 42 U.S.C.

§ 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act) HRSA-23-106 IMHS i # 508 COMPLIANCE DISCLAIMER Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII.

Agency The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Integrated Maternal Health Services program.

The purpose of this program is to foster the development and demonstration of integrated maternal health services models, such as the Maternity Medical Home (sometimes referred to as the Pregnancy Medical Home (PMH)), which is modeled after the patient-centered medical home 1.

The models developed and demonstrated by this program support comprehensive care (including clinical, ancillary, behavioral health, and support services) for pregnant and postpartum people who experience health disparities and have limited access to basic social and health care services.

The primary goal of this initiative is to identify integrated health services models for future replication that will improve maternal health outcomes, advance health equity, and address systemic barriers.

Funding Opportunity Title: Integrated Maternal Health Services Funding Opportunity Number: HRSA-23-106 Due Date for Applications: May 24, 2023 Anticipated FY 2023 Total Available Funding: Estimated Number and Type of Award(s): Up to 5 cooperative agreements Estimated Annual Award Amount: Up to $1,800,000 per award per year Cost Sharing/Match Required: No Period of Performance: September 30, 2023 through > 1https://www. ihi.

org/communities/"The Maternity Medical Home: The Chassis for a More Holistic Model of Eligible Applicants: Any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C. § 450b) is eligible to apply. For your reference, see 42 CFR § 51a.

3(a). Domestic faith-based and community- based organizations are eligible to apply. For your reference, see 45 CFR part 87.

See Section III. 1 of this notice of funding opportunity (NOFO) for complete eligibility information. You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Application Guide .

Visit HRSA’s How to Prepare Your Application page for more information. HRSA has scheduled the following webinar: gov.zoomgov. com/j/1601096631?

pwd=d3A1TW03Mk41cUZJYm93NW90bXdtZz09 Attendees without computer access or computer audio can use the dial-in information below. Call-In Number: 1-833-568-8864 MCHB will provide an overview of the NOFO and an opportunity to ask questions. HRSA will record the webinar and make it available at: https://mchb.

hrsa. gov/fundingopportunities/default. aspx .

HRSA-23-106 IMHS iii I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION....................................................... 1 1.

PURPOSE ...................................................................................................................... 1 2. BACKGROUND ................................................................................................................

2 II. AWARD INFORMATION .................................................................................................... 4 1.

TYPE OF APPLICATION AND AWARD .................................................................................. 4 2. SUMMARY OF FUNDING ...................................................................................................

5 III. ELIGIBILITY INFORMATION ............................................................................................. 6 1.

ELIGIBLE APPLICANT S ..................................................................................................... 6 2. COST SHARING/MATCHING ..............................................................................................

6 3. OTHER .......................................................................................................................... 6 IV.

APPLICATION AND SUBMISSION INFORMATION .......................................................... 6 1. ADDRESS TO REQUEST APPLICATION PACKAGE.................................................................

6 2. CONTENT AND FORM OF APPLICATION SUBMISSION ........................................................... 7 i.

Project Abstract................................................................................................. 13 ii. Project Narrative................................................................................................

13 iii. Budget ............................................................................................................... 20 iv.

Budget Narrative ............................................................................................... 20 v. Attachments ......................................................................................................

21 3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM) ............. 23 4.

SUBMISSION DATES AND TIMES ..................................................................................... 24 5. INTERGOVERNMENT AL REVIEW ......................................................................................

24 6. FUNDING RESTRICTIONS ............................................................................................... 24 V.

APPLICATION REVIEW INFORMATION.......................................................................... 25 1. REVIEW CRITERIA.........................................................................................................

25 2. REVIEW AND SELECTION PROCESS ................................................................................ 29 3.

ASSESSMENT OF RISK................................................................................................... 30 VI. AWARD ADMINISTRATION INFORMATION...................................................................

31 1. AWARD NOTICES .......................................................................................................... 31 2.

ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENT S ................................................. 31 3. REPORTING .................................................................................................................

33 VII. AGENCY CONTACTS.................................................................................................... 35 VIII.

OTHER INFORMATION ................................................................................................ 36 APPENDIX A: PAGE LIMIT WORKSHEET ........................................................................... 37 APPENDIX B: ADDITIONAL INFORMATION FOR APPLICANTS .........................................

39 HRSA-23-106 IMHS 1 # I. Program Funding Opportunity Description This notice announces the opportunity to apply for funding under the FY 2023 Integrated Maternal Health Services (IMHS) program.

The purpose of this program is to foster the development and demonstration of integrated health services models, such as the Maternity Medical Home (sometimes referred to as the Pregnancy Medical Home (PMH)) which is modeled after the patient-centered medical home 2.

The models developed and demonstrated by this program will support comprehensive care (including clinical, ancillary, behavioral health, and support services) for pregnant and postpartum people who experience health disparities and have limited access to basic social and health care services.

The IMHS initiative will be used to identify integrated health services models for future replication that will improve maternal health outcomes, advance equity, and address systemic barriers.

The overarching goal of the IMHS initiative is to improve maternal health outcomes in the United States by increasing access to quality, equitable, comprehensive care for pregnant and postpartum people who experience health disparities and have limited access to basic social and health care services.

The program will work towards achieving this goal by: • Fostering collaborative relationships between health care providers, social services organizations/providers, state Medicaid programs, and state and local health departments to coordinate services and improve maternal health outcomes; • Developing and enhancing maternal health data infrastructure at the maternal health care practice and population levels; • Assessing the viability of various models that support integrated health services for pregnant and postpartum people; and, • Identifying lessons learned for future implementation.

> 2http://www. ihi.

org/communities/ "The Maternity Medical Home: The Chassis for a More Holistic Model of The objectives to be accomplished during the period of performance to support the initiative’s overarching goal include: • By September 29, 2025, 100% of recipients will implement a model that includes all core strategies and activities; and, • By September 29, 2028, funded demonstrations will report data for key measures by race and ethnicity, at a minimum, to evaluate disparities; and, • By September 29, 2028, funded demonstrations will have incorporated strategies that deliberately address disparities.

• By 2028, identify at least one successful integrated services model for replication and scale-up. For more details, see Program Requirements and Expectations . The Integrated Maternal Health Services program is authorized by 42 U.S.C.

§ 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act). Under this authority, funding is made available for special projects of regional and national significance in maternal and child health and supports MCHB’s aim to improve the health and well-being of America’s mothers, children, and families. To learn more about MCHB’s programs and investments visit http://www.

mchb. hrsa. gov. Approximately 3.

6 million women give birth in the United States each year 3 and, despite advances in medical care and investments in improving access to care, rates of maternal mortality and severe maternal morbidity (SMM) have not improved. In 2020, there were 861 maternal deaths in the U.S., an increase from 754 in 2019, representing a maternal mortality rate of 23. 8 per 100,000 live births.

4 In addition, thousands of women experience unintended outcomes of labor or delivery, resulting in significant short- or long-term consequences to their health. In 2020, more than 30,000 women experienced SMM (not including those who only received a blood transfusion).

5 Significant maternal health disparities exist in maternal mortality, SMM, and other adverse outcomes, with outcomes varying by race, ethnicity, geography, and select > 3https://www. cdc. gov/nchs/fastats/births.

htm > 4https://www. cdc. gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.

htm > 5 HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP). December 2022.

Agency for Healthcare Research and Quality, Rockville, MD. http://datatools. ahrq.

gov//hcup-fast- > stats? type=subtab&tab=hcupfsse&count=3 indicators of socio-economic status. 6 7 To address this growing problem, the Maternal and Child Health Bureau (MCHB) supports national, state, and local efforts to improve maternal health.

Several of the programs funded by MCHB are testing innovative strategies with a goal to identify those most effective at addressing adverse maternal health outcomes and accelerating progress to improve maternal health. One innovative strategy for integrated maternal health services specifically is the Pregnancy Medical Home (PMH) model.

The Agency for Healthcare Research and Quality (AHRQ) defines a medical home as a model of the organization of primary care that delivers core functions and attributes of primary health care, including comprehensive, patient-centered and coordinated care; accessible services; and quality and safety.

8 The PMH, which is modeled after the patient-centered medical home 9,incorporates several key elements, including a standardized risk assessment; focus on early entry to prenatal care; care coordination by a nurse, social worker, or other health care professional; standardized care pathways; enhanced access; and patient-centered care.

The PMH model has been implemented in some areas of the United States with a focus on promoting high-quality maternity care through coordinated, evidence-based maternity care management to improve perinatal outcomes in the pregnant Medicaid population.

Previous assessments of several PMH models show positive impact on perinatal outcomes (i.e., fewer cesarean births and decreased rate of low birth weight infants) and healthcare utilization (i.e., improved postpartum visit rate). 10 11 12 The impact on maternal health outcomes is unclear.

More evidence is needed to demonstrate the impact of the PMH model on maternal health and health equity, and HRSA seeks to build that evidence through this Integrated Maternal Health Services initiative. > 6 Maternal Mortality Rates in the United States, 2020 (cdc. gov) > 7 Severe Maternal Morbidity after Delivery Discharge among U.S. Women, 2010-2014 | CDC > 6https://pcmh.

ahrq. gov/page/defining-pcmh > 9 http://www. ihi.

org/communities/"The Maternity Medical Home: The Chassis for a More Holistic Model of Pregnancy Care?" > 10 https://www. ncmedicaljournal.

com/content/76/4/263 > 11 https://www. nashp. org/wp-content/uploads/2017/10/Wisconsin-Case-Study-Final.

pdf > 12 http://texasperinatalservices. org/wp-content/uploads/2018/12/HHSC_State-Efforts-to-Address- > Maternal-Mortality-and-Morbidity.

pdf Goal 1: Assure access to high quality and equitable health services to optimize health and well-being for all MCH populations Goal 2: Achieve health equity for MCH populations Goal 3: Strengthen public health capacity and workforce for MCH Goal 4: Maximize impact through leadership, partnership, and stewardship 1.

Type of Application and Award Type(s) of applications sought: New HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

In addition to the usual monitoring and technical assistance (TA) provided directly to award recipients, HRSA program involvement will include: • Having experienced HRSA personnel available as participants in the planning and development of all phases of the demonstration; • Participating, as appropriate, in conference calls, meetings, and technical assistance sessions that are conducted during the period of the cooperative agreement; • Coordinating the partnership and communication with federally-funded maternal health programs and other federal entities that may be relevant for the successful completion of tasks and activities identified in the approved scope of work; • Conducting an ongoing review of the establishment and implementation of activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement; and, • Participating with the recipient in the dissemination of findings, best practices, and lessons learned from the demonstration.

HRSA-23-106 IMHS 5 In addition to adhering to all applicable federal regulations and public policy requirements, the cooperative agreement recipient’s responsibilities will include: • Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.

2 of the Application Guide ( Acknowledgement of Federal Funding ); • Completing activities proposed in response to the Program Requirements and Expectations section of this notice of funding opportunity; • Providing the federal project officer with the opportunity to review and discuss any publications, audiovisuals, and other materials produced, as well as meetings planned, through this cooperative agreement.

Such review should start at the time of concept development and include review of drafts and final products; • Participating in technical assistance (TA) and capacity-building activities provided by the designated TA provider, including participation at an annual meeting hosted by the TA provider; • Participating in evaluation activities provided by the designated HRSA evaluation contractor; • Participating with HRSA in face-to-face meetings and conference calls conducted during the period of the cooperative agreement; • Consulting with the federal project officer when scheduling any meetings that pertain to the scope of work and at which the project officer’s attendance would be appropriate (as determined by the project officer); • Collaborating with HRSA on ongoing review of activities, procedures, budget items, contracts, and subawards, as well as information/publications prior to dissemination; and, • Completing all administrative data and performance measure reports, as designated by HRSA, in a timely fashion.

HRSA estimates approximately $9,000,000 to be available annually to fund up to 5 recipients. You may apply for a ceiling amount of up to $1,800,000 total cost (reflecting direct and indirect costs) per year. The period of performance is September 30, 2023 through September 29, 2028 (5 years).

Funding beyond the first year is subject to the availability of appropriated funds for Integrated Maternal Health Services in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government. HRSA-23-106 IMHS 6 All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75 . # III.

Eligibility Information Eligible applicants include any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C. 5304 (formerly cited as 25 U.S.C. 450b)).

See 42 CFR § 51a. 3(a). Domestic faith-based and community-based organizations are eligible to apply.

Cost sharing/matching is not required for this program. HRSA may not consider an application for funding if it contains any of the non-responsive criteria below: • Exceeds the funding ceiling amount • Fails to satisfy the deadline requirements referenced in Section IV. 4 Multiple applications from an organization are not allowed.

HRSA will only accept and review your last validated electronic submission before the Grants. gov application due Only one cooperative agreement will be funded within a state under this notice. For more details, see Section V.

2. Review and Section Process . # 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 . 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 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, and certifications.

You must submit the information outlined in HRSA SF-424 Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in this NOFO and HRSA’s SF-424 Application Guide . 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 to assist you in completing your application.

The total number of attachment pages that count toward the page limit shall be no more than 50 pages when we print them. HRSA will not review any pages that exceed the page limit. We will remove any pages that exceed the page limit starting with the last printed page.

These attachments 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 attachments that don’t count toward the page limit, we’ll make this clear in Section IV. 2. v Attachments .

If you use an OMB-approved form that isn’t in the HRSA-23-106 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.

Once any excess pages are removed from an application, HRSA will determine eligibility using Section 3. Eligibility Information . Applications must be complete and validated by Grants.

gov under HRSA-23-106 before the deadline .

HRSA-23-106 IMHS 8 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 Attachment 8: Other Relevant Documents . See Section 4.

1 viii of HRSA’s SF-424 Application Guide for additional information on all Program Requirements and Expectations You are required to propose a plan to successfully launch your project within the first year of funding and establish the IMHS demonstration at the state 13 level or one or more regions within the state to support the population with the greatest unmet need.

You should develop strong partnerships with family leaders and community members who have lived experiences with health and social services in the development of your demonstration, and integrate their needs and perspectives into program design, decision making, and performance assessment.

You should take into consideration the target population and scope of your demonstration’s intended IMHS model when writing your application to maximize reach, impact, and equity in maternal health. Applications should not duplicate existing activities, nor should funds be used to supplant current activities.

You are expected to work with relevant stakeholders to develop and carry out the IMHS model for your demonstration, including collaborating at the state-level to strengthen capacity in achieving project aims and building on other HRSA maternal health programs.

Your demonstration is expected to achieve the purpose and overarching goal listed within the Purpose section of this NOFO by including the following core strategies and activities within your IMHS model: 1) Integrated Maternal Health Services Establish an integrated health services model of care for your demonstration that includes: > 13 This NOFO uses the terms “state” and state-level for brevity, but is inclusive of an organization at the state, jurisdiction, territory, or tribal community level that may be applying for funding.

Tribal community refers to an Indian tribe or tribal organization. See also the definition of “state” in PHS Act, § 2(f) . • Routine use of a standardized risk assessment for pregnant people to identify those at greater risk for adverse maternal health outcomes.

The risk assessment should be conducted during the first prenatal care visit or as early as possible in the pregnancy. Integration of the risk assessment into each practice’s electronic health record system is recommended.

• Provision of pregnancy care management and care coordination for people identified to be at greater risk for adverse maternal health outcomes, such as those who experience health disparities and have limited access to basic social, behavioral, and health care services. For the purposes of this NOFO, pregnancy care management should occur during pregnancy and continue throughout the 12-month postpartum period.

Coordinated pregnancy care management should include: o Monitoring of preventive and wellness care during pregnancy and throughout the postpartum period; o Referrals for specialized care and support services to address clinical (medical and obstetric), ancillary, behavioral health, and social/support needs; o Team-based and patient-centered approach designed to address the increasing complexity of care in outpatient settings; 14 and, o Culturally and linguistically appropriate, respectful, patient 15 - and family-centered services that focus on listening to, informing, educating, and involving patients in their care.

Your demonstration is expected to foster collaborative relationships and community-clinical linkages between health care providers, social services organizations/providers, state Medicaid programs, and state and local health departments to provide seamless coordination of services and improve maternal health outcomes.

If the design of your integrated health services model includes incentivizing providers and health care systems (e.g., Medicaid reimbursement, monetary payments for completed risk screens) to support comprehensive maternal health care, you should consider partnering with your state Medicaid program, if feasible. Include applicable letters of agreement in Attachment 4 . > 14 https://www.

ahrq. gov/ncepcr/care/coordination/mgmt. html > 15 The Institute of Medicine define patient-centered care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions” -Institute of Medicine.

"Crossing the Quality Chasm: A New Health System for the 21st Century" 2) IMHS “Local-Level” 16 Workforce In order to better serve the individual needs of the pregnant and postpartum people, you are encouraged to establish a diverse workforce reflective of populations served, which may include, but is not limited to, racial and ethnic diversity.

The workforce should be established in a way that fosters collaboration among health care providers and care managers to support pregnancy care management, care coordination, and quality improvement (QI) in maternal health care practices.

Establishing this workforce includes: • Recruitment of maternal health care practices (e.g., obstetrics, family practice, certified nurse midwives) and workforce 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.

• Training of OB providers and workforce that includes culturally and linguistically appropriate services, trauma-informed care, implicit bias, motivational interviewing, and social determinants of health. 3) Region-Level Coordination and Support Every project will have at least one “region”; a smaller state may be one region.

Your project may include more than one region if it is designed to cover a larger portion of your state or the entire state. You are expected to include region-level coordination of and support for pregnancy care management by an OB provider and a regional coordinator.

Each region-level provider/coordinator team is responsible for working with the maternal health care practices in their region to ensure the local-level workforce is implementing the intended IMHS model.

Establishing the provider/coordinator team includes: • Recruitment of OB provider(s) (e.g., OB/GYNs, certified nurse midwives, family practice physicians) who are well versed in evidence-based practices and have experience in implementing QI in maternal health care to oversee the IMHS model of care.

They should be able to develop standardized approaches (e.g., clinical pathways) for care delivery, promote best practices, set performance expectations, and provide subject matter expertise and guidance for the health care practices.

• Recruitment of regional coordinator(s) (e.g., OB nurses) who have experience in implementing QI methods in maternal health care to oversee pregnancy care > 16 Note: While this part of the workforce is denoted as being “local-level”, these are flexible to what grantees envision as “local” for their projects.

For example, local-level workforce could be working with pregnant or post-partum people across a state, if the individuals to be served are within a small state. management and care coordination activities and provide training and support to the local-level workforce (e.g., nurses, social workers, community health workers).

4) Data, Information Management, and Evaluation You should establish a system to guide QI, track performance measures, monitor outcomes, and support overall program performance evaluation. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the demonstration.

The system should include: • Real-time practice-level data and analytics that are accessible to, and reviewed by, participating practices to inform QI strategies and monitor progress; • Collection and use of data stratified by race, ethnicity, and social factors to assess the impact of the IMHS model on health equity and health disparities; and, • Key quality and performance measures to identify and track care management and care coordination activities to ensure that people who are at greater risk for adverse maternal health outcomes are receiving needed services.

You could consider having your system support linkage of administrative data (e.g., birth certificates, fetal death records, Medicaid claims) with standardized risk assessments, care management, and other pertinent datasets. If this is possible and incorporated, it may allow you to track performance measures, monitor outcomes, support overall evaluation activities for the demonstration, and guide QI within the health care practices.

You are also expected to collect, track, and report annually on measures to show progress on program objectives.

These measures may include, but are not limited to: • The number of health care practices recruited to implement the IMHS model; • The number of providers recruited and trained in pregnancy care management and care coordination; • The number of individuals recruited and trained to deliver pregnancy care management and care coordination; • The number of individuals (OB providers and care pregnancy management workforce) trained in culturally and linguistically appropriate services, trauma-informed care, implicit bias, motivational interviewing, and social determinants of health; • The number of pregnant people receiving a standardized risk assessment; HRSA-23-106 IMHS 12 • The percent of people identified at greater risk for adverse maternal health outcomes who receive pregnancy/postpartum care management; • The percent of people identified as having clinical, behavioral health, and/or social needs who receive appropriate services; • The percent of pregnant people who receive prenatal care starting in the first trimester; • The percent of pregnant people who receive a comprehensive postpartum visit no later than 12 weeks after birth; • The percent of postpartum people transitioning to appropriate primary/specialty care; • Total number of live births; • Total number of pregnancy-related deaths; • Rate of severe maternal morbidity; • Number of people with insurance coverage; and, • Number of people screened for maternal depression (including postpartum depression).

5) Community Partnerships and Health Equity Across all activities, HRSA expects recipients to focus on equity, diversity, inclusion, and accessibility to address systemic barriers, including racism, and to meet community needs. Activities should aim to advance equity in access to health and social services as well as health outcomes.

Your demonstration should: • Prioritize recruiting practices that serve communities with the greatest health and family well-being needs (e.g., those with populations that have been historically marginalized and underserved); and, • Develop strong partnerships with family leaders and community members who have lived experiences with health and social services and include compensation or other fair supports for contributors.

# 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: HRSA-23-106 IMHS 13 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 . 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 Needs Assessment (1) Need Methodology (2) Response and (4) Impact Work Plan (2) Response and (4) Impact Resolution of Challenges (2) Response Evaluation and Technical Support Capacity (3) Evaluative Measures and (5) Resources/Capabilities Organizational Information (5) Resources/Capabilities Budget Narrative (6) Support Requested 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 V’s Review Criterion #1 Need Briefly describe the purpose of the proposed demonstration.

 NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 Need o Provide the most recent estimates for key maternal health outcomes at the state level, including the total number of live births, total number of HRSA-23-106 IMHS 14 maternal deaths, maternal mortality rate (maternal deaths per 100,000 live births), rate of severe maternal morbidity (SMM), and other related maternal health indicators (e.g., percentage of people with health insurance, median age at time of first birth, rate of cesarean section deliveries, percentage of women who received a postpartum visit, percentage of women screened for postpartum depression, etc.).

o Outline the maternal health needs of your state and the region(s) to be served. Describe the geographic and demographic disparities in adverse maternal health outcomes as experienced by your state that will be addressed by your IMHS demonstration, including access to health care (e.g., percentage of people with health insurance, OB provider-patient ratio).

Describe factors that contribute to maternal mortality and SMM within the state, including systemic and individual factors. o Describe and document the target population. Describe the unmet health and social needs your demonstration will serve, and how those unmet health needs and health disparities experienced by the target population contribute to maternal mortality, SMM, and other adverse maternal health outcomes.

This section will help reviewers understand the state maternal health outcomes in relation to the proposed project.  METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 Response and o Propose methods that you will use to establish an IMHS demonstration in your state, meet each of the previously described Program