This notice announces the limited competition opportunity to apply for funding under the Telehealth Centers of Excellence (COEs) Program. The primary purpose of this program is to assess specific telehealth1 uses and services to improve health care in rural areas. The Telehealth COEs are located in public academic medical centers that: • Have a successful telehealth program with a high annual volume of telehealth visits; • Have an established reimbursement structure that allows telehealth services to be financially self-sustaining; and • Have established programs that provide telehealth services in medically underserved areas with high chronic disease prevalence and high poverty rates. The Telehealth COEs will serve multiple roles, including telehealth incubators to pilot, track and refine telehealth research with the goal of establishing evidence-based telehealth programs and framework that could be shared and instituted in a future evidence-based telehealth network program to improve health care in rural areas. To achieve that goal, the Telehealth COEs have substantial experience operating a telehealth program that offers a broad range of clinical services and has experience demonstrating how their efforts have improved access to care and enhanced health outcomes for their patients. The Telehealth COEs use that expertise to test out new and or innovative uses of telehealth to provide an initial assessment of their potential and identify whether those assessments are viable to be expandable models. The range of telehealth services has expanded over the past several decades and in 2020, experienced rapid increase in usage. Traditional telehealth models deliver care to patients at a series of originating (or spoke) sites from a specialist working at a distant (or hub) site. It has proven capabilities to reduce travel time, increase access to care, and improve patient safety, quality of care, and provider support. “By increasing access to physicians and specialists, telehealth helps ensure patients receive the right care, at the right place, at the right time2.” In addition, in March 2020 the American Medical Association (AMA) reports, “Telehealth allows us to reach more patients while protecting the health care workforce3.” Rural areas, particularly those with high rates of chronic disease and poverty, can benefit from using telehealth technology to receive vital health care services close to home. The award recipients for the Telehealth COE work closely and collaborate with other relevant entities, including other HRSA-funded award recipients. In particular, the Telehealth COE recipient will work closely with the National and Regional Telehealth Resource Centers (TRCs)4, the Telehealth-Focused Rural Health Research Centers (RHRCs) and the License Portability program5. The Regional TRCs provide technical assistance to consumers, care organizations, networks and providers to implement cost-effective telehealth programs to serve rural and medically underserved areas and populations as well as serve as focal points for advancing the effective use of telehealth technologies in their respective states. There are two National TRCs, one with a focus on telehealth policy and one with a focus on telehealth technology, which support the Regional TRCs. The purpose of the RHRCs is to conduct and maintain a thorough and comprehensive evaluation of nationwide telehealth investments in rural areas and populations and conduct clinically informed and policy-relevant research to expand the evidence base for rural telehealth services. The Telehealth COEs will serve a distinct purpose from the programs described above, but it is important that all four programs work collaboratively with HRSA to ensure that work plans are complementary and work towards the overarching goal of growing telehealth nationally. The Telehealth COEs will share expertise operating a successful, high volume, clinically diverse telehealth program and will use that base to explore new telehealth applications, examine the efficacy of specific uses of telehealth, and identify strategies and resources to assist others to effectively integrate telehealth into the broader rural health care delivery system and examine the impact of telehealth on federal health care spending. In order to support this goal, each Telehealth COEs will create and share resources. This will include managing an independent location to post projects, data and resources and provide opportunity for public request for information. In addition, some resources created by the Telehealth COEs will be selected and featured on the HHS Telehealth Website (www.telehealth.hhs.gov). Telehealth COEs will need to effectively demonstrate national and/or regional impact over the period of performance, and how telehealth programs and networks can improve access to health care services in rural areas, particularly those with high rates of poverty and chronic disease. To that end, the Telehealth COE recipients will gather and submit performance data (including clinical and claims data) on a wide range of telehealth metrics related to the overall purpose of the funding opportunity to examine the efficacy of telehealth services in rural areas. Important: This NOFO is not intended to fund the development or expansion of a telehealth network. Applicants must have an existing telehealth program that meets the requirements outlined in this notice.
The eligible applicants for this funding opportunity are public academic medical centers located in states with high chronic disease prevalence, high poverty rates, and a large percentage of medically underserved areas. For the purposes of this funding notice,
limited competition eligible applicants are currently participating in the Telehealth Center of Excellence program and are located in a state where the chronic disease prevalence among Medicare beneficiaries is equal to or above the national prevalence for at least three of the following chronic conditions (cms.gov portal):
• High Blood Pressure/Hypertension
• Heart Disease
• Chronic Kidney Disease
The data file can be found on the Centers for Medicare and Medicaid website, Medicare Chronic Conditions Dashboard.
High Poverty Rates – Applicants are located in a state with a Federal Medical Assistance Percentage (FMAP) at or above 65.0 percent. The 2021 FMAP percentages can be found at: FAS FMAP.
Medically Underserved Areas – Applicants are located in states where at least 85 percent of the counties (either the entire county or a smaller division within the county)
have been designated as a medically underserved area (MUA). More information about MUAs, including analyzers can be found at MUA Find.
Rurality – Applicants may be located in an urban area but must provide telehealth services to rural areas in applicant’s state in order to receive funding. Applicants must
include a list of rural health care facilities in state where telehealth services are currently
provided. To determine whether the facility is located in a rural area see: Rural Health Grants Eligibility Analyzer.
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.
Applicants should list the locations that will be served and identify rural. Please include the rural census tract(s) in the Project Abstract. The applicant organization should also describe their experience and/or capacity serving rural populations in the Project Abstract section of the application. It is important that applicants list the rural locations (or rural census tract(s) if the county is partially rural) that will be served through their proposed projects, as this will be one of the factors