BHW COMBO_ HRSA-25-077-HRSA-25-091 THCGME (T91) FINAL.pdf

Issuance Date: 07/19/2024

HRSA-25-077

Application Due 09/20/2024

HRSA-25-091

Application Due 09/05/2024

Bureau of Health Workforce Division of Medicine and Dentistry

Teaching Health Center Graduate Medical Education (THCGME) Program Opportunity number: HRSA-25-077 Opportunity number: HRSA-25-091

Step 1: Review the Opportunity

Basic information Summary

Key dates

Funding detail

Eligibility Types of eligible organizations

Cost sharing

Program description

Purpose

Background

Program goal

Program Objectives

Program requirements and expectations

Funding policies & limitations

Step 2: Get Ready to Apply

Get registered SAM.gov

Grants.gov

Find the application package

Application writing help Join the webinar

Step 3: Write Your Application

Application contents & format Project abstract

Project narrative

Budget & budget narrative

Attachments

Other required standard forms

Form instructions

Step 4: Learn About Review & Award

Application review

Initial review

Merit review

Risk review

Selection process

Award notices

Step 5: Submit Your Application

Application submission & deadlines Deadlines

Submission method

Other submissions

Application checklist

Step 6: Learn What Happens After Award

Post-award requirements & administration Administrative & national policy requirements

Non-discrimination & assurance

Reporting

Contacts & Support

Agency contacts Program & eligibility

Financial & budget

HRSA Contact Center

Grants.gov SAM.gov Program specific definitions Helpful websites Appendix A: Assurances Document Appendix B: Eligible Resident/Fellow FTE Chart

Jump to a step

1. Review 2. Get ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information

Eligibility

Program description

HRSA-25-077 & HRSA-25-091 1

Basic information The key facts

Bureau of Health Workforce

Division of Medicine and Dentistry

Opportunity name: Teaching Health Center Graduate Medical Education (THCGME) Program

Opportunity numbers: HRSA-25-091 and HRSA-25-077

Federal Assistance Listing Number: 93.530

Statutory authority: 42 U.S.C. 256h (Section 340H of the Public Health Service (PHS) Act)

Summary The purpose of the THCGME Program is to support the training of residents in primary care residency programs in community-based ambulatory patient care centers. These residency programs will prepare residents to provide high quality care, particularly in rural and underserved communities, and develop competencies to serve these diverse populations and communities.

Funding under HRSA-25-091 will support residents starting in academic year 2024-2025.

Funding under HRSA-25-077 will support residents starting in academic year 2025-2026.

This funding will support both the direct expenses associated with sponsoring approved graduate medical residency training programs and indirect expenses associated with the additional costs related to teaching residents in residency training programs. The funding is available for expansion of existing approved residency programs and the establishment of newly approved residency programs.

Note: You must apply to the correct announcement number (HRSA-25-091 or HRSA-25-077) that corresponds to the stated dates listed below. These notices are for multiyear funding. If you are funded under HRSA-25-091, you will be funded beginning AY 24-25, and you do not need to then apply for AY 25-26 funding.

Have questions?

Go to Contacts & Support.

Key dates Application deadline:

• HRSA-25-091: September 5, 2024

• HRSA-25-077: September 20, 2024

HRSA-25-077 & HRSA-25-091 2

NOFO issue date: July 19, 2024

Expected award date is by:

• HRSA-25-091: November 1, 2024

• HRSA-25-077: June 30, 2025

Expected start date:

• HRSA-25-091: November 1, 2024

• HRSA-25-077: July 1, 2025

Funding detail

HRSA-25-091

Application Type: New

Expected total available FY 2025 funding: $10 million

Expected number and type of awards: 6 awards

Funding range per award: $160,000 to $10,000,000 per award

The FY 2025 HRSA THCGME Program payment is formula-based and provides a payment for both Direct Medical Education (DME) and Indirect Medical Education (IME) expenses. The FY 2025 per resident amount will be $160,000 per resident FTE.

For HRSA-25-091 only, you may incur pre-award project costs 90 calendar days before the Federal award date. Payments made through this announcement are to only be used for the direct expenses associated with sponsoring an approved graduate medical residency training program and indirect expenses associated with the additional costs relating to teaching residents in residency training programs. All costs incurred before we issue the Notices of Award (NoA) must comply with the Notice of Funding Opportunity (NOFO) requirements. We are under no obligation to reimburse such costs if for any reason you do not receive an award, costs are in conflict with the Cost Principles, or if the dollar amount of the award is less than anticipated and inadequate to cover such costs.

We plan to fund new and expansion awards in four budget periods for a period of performance of November 1, 2024, to June 30, 2029.

HRSA-25-077 & HRSA-25-091 3

Period of Performance Budget Period Start Date Budget Period End Date

Year 1 November 1, 2024* June 30, 2026

Year 2 July 1, 2026 June 30, 2027

Year 3 July 1, 2027 June 30, 2028

Year 4 July 1, 2028 June 30, 2029

*As noted earlier, pre-award costs incurred between August 1, 2024 and October 31, 2024 may be charged to this budget period.

HRSA-25-077

Application Type: New

Expected total available FY 2025 funding: $80 million

Expected number and type of awards: 41 awards

Funding range per award: $160,000 to $10,252,864 per award

The FY 2025 HRSA THCGME Program payment is formula-based and provides a payment for both DME and IME expenses. The FY 2025 per resident amount will be $160,000 per resident

FTE.

This NOFO is being issued for administrative purposes should funding become available. The program and estimated number of awards depend on the future appropriation of funds and are subject to change based on the availability and amount of appropriations. The total expected funding of $80 million is based on requested amount for the Teaching Health Center GME program included in the President’s Budget for FY 2025 and depends on Congressional action to appropriate the funds.

We plan to fund new or expansion awards in four 12-month budget periods for a total 4-(four) year period of performance of July 1, 2025, to June 30, 2029.

Period of Performance Budget Period Start Date Budget Period End Date

Year 1 July 1, 2025 June 30, 2026

Year 2 July 1, 2026 June 30, 2027

Year 3 July 1, 2027 June 30, 2028

Year 4 July 1, 2028 June 30, 2029

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can return to where you were by pressing Alt + Backspace.

HRSA-25-077 & HRSA-25-091 4

Eligibility Who can apply

You can apply if you are a community-based ambulatory patient care center that operates an accredited primary care residency program, or has formed a GME consortium that operates an accredited primary care residency program, in one of the following specialties/disciplines:

• Family Medicine

• Internal Medicine

• Pediatrics

• Internal Medicine-Pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

Types of eligible organizations If otherwise eligible, these types of domestic organizations (see note) may apply:

An eligible entity is a community-based ambulatory patient care center that:

i. Operates an accredited primary care residency program; or

ii. Has formed a GME consortium that operates an accredited primary care residency program

a. In order to satisfy accreditation, academic and administrative responsibilities, a community-based ambulatory patient care center may form a GME consortium with partners (e.g., academic health centers, universities and/or medical schools, teaching hospitals, and critical access hospitals) where the GME consortium serves as the institutional sponsor of an accredited primary care residency program.

b. The relationship between the community-based ambulatory patient care center and the consortium must be legally binding, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

HRSA-25-077 & HRSA-25-091 5

c. Within the consortium, the community-based ambulatory patient care center is expected to play an integral role in the academic, financial, and administrative operations of the residency.

d. Teaching hospitals and academic institutions can be part of a GME consortium to assist with academic and administrative responsibilities.

Teaching hospitals and academic institutions are NOT eligible recipients of THCGME funding.

The list provides examples of community-based ambulatory patient care centers. This list is not exhaustive but does reflect the intent of the program to support training in settings such as those served by the institutions listed below.

Note: “Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Community-based Ambulatory Patient Care Center

• Federally Qualified Health Centers (FQHC)

• Community Mental Health Centers (CMHC)

• Rural Health Clinics

• Health Centers operated by the Indian Health Service (IHS)

• Health Centers operated by Tribes or Tribal Organizations

• Health Centers operated by Urban Indian Organizations

• Entities receiving funds under Title X of the PHS Act

Cost sharing This program has no-cost sharing requirement.

Program description

Purpose The purpose of the THCGME Program is to support the training of residents in primary care residency training programs in community-based ambulatory patient care centers. These residency programs will prepare residents to provide high-quality care, particularly in rural and underserved communities, and develop competencies to serve these diverse populations and communities. These notices announce the

HRSA-25-077 & HRSA-25-091 6

opportunity to apply for funding under the THCGME Program.

This funding will support both the direct expenses associated with sponsoring approved graduate medical residency training programs and indirect expenses associated with the additional costs relating to teaching residents in residency training programs.

Two award types are available:

1. Expansion awards for an increased number of resident Full-Time Equivalent (FTE) positions at existing HRSA THCGME Programs.

2. New awards to support new resident FTE positions at new Teaching Health Centers (THCs). New THCs are those applicants seeking funding for residency programs that have never received payment under the HRSA THCGME Program for the applicable residency program in any previous fiscal year.

As described in 340H(h)(2)(B), all resident FTEs for whom THCGME support is requested must be above the program’s resident FTE baseline and must not put the program above the number approved by or awaiting approval by, the relevant accrediting body. Please review program objectives for more information.

Background

The National Center for Health Workforce Analysis (NCHWA) projects that the total demand for primary care physicians will grow by 43,280 FTEs between 2021 and 2036.

NCHWA predicts an 8 percent increase in national demand for oral health professionals (that includes endodontists, general dentists, oral surgeons, orthodontists, pediatric dentists, periodontists, and other dentists) seeing a rise by 15,380 FTEs in 2036. While the overall supply of some oral health professionals may meet the projected demand for their professions, NCHWA data shows shortages in general dentistry for all years covered by the current projections (2021-2036).

The THCGME Program was started to meet the growing need for primary care and to offer a new model focusing on training physicians and dentists in places outside hospitals.

The THCGME Program strengthens the primary care workforce by providing funding to community-based organizations in order to focus on medical and dental training in community settings, especially aimed at rural and underserved areas. Its unique approach contrasts with the traditional GME models based in urban centers by:

• Training in community health settings; and

• Increasing the likelihood of graduates practicing in underserved areas.

HRSA-25-077 & HRSA-25-091 7

Evidence shows that this model effectively places physicians in high-need locations.1 2

Program goal To utilize the THCGME per resident amount established by the Secretary, inclusive of both DME and IME expenses, to support the costs associated with resident FTE training in a community-based ambulatory patient care center.

Program Objectives Applicants must support the training of primary care residents in an approved graduate medical residency training program in a community-based setting (see Program specific definitions).

All applicants must designate the number of resident FTEs they are requesting support for under this NOFO. Resident FTE requests may not exceed the number approved by the relevant accrediting body and must be made according to the following requirements:

1. Expansion (new applications) – Existing HRSA THCGME residency program recipients may request expansion of resident FTEs above the baseline, which, for the purposes of this NOFO, is the number of resident FTEs trained by the program in Academic Year (AY)

2023-2024 for HRSA-25-091 and the number of resident FTEs trained by the program in

AY 2024-2025 for HRSA-25-077. Such expansion requests can only be made for resident

FTEs currently not otherwise funded by HRSA if the requested resident FTEs are not supported by other funding sources by the period of performance start date (HRSA-25-

091 November 1, 2024 and HRSA-25-077 July 1, 2025).

a. If applying for HRSA-25-091 training of newly supported THCGME residents must start in AY 2024-2025

b. If applying for HRSA-25-077 training of newly supported THCGME residents must start in AY 2025-2026.

Existing THCGME Residency Programs that wish to request support for an expanded number of resident FTEs beyond the number stated in their most recent HRSA THCGME Program Resident

FTE Approval Letter must submit an application for the expanded number of resident FTEs.

1 Phillips RL, Petterson S, Bazemore, A. Do residents who train in safety net settings return for practice? Academic Medicine. 2013; 88(12): 1934–1940.

2 Goodfellow A, Ulloa J, Dowling P, et al. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Academic Medicine. 2016; 91(9): 1313– 1321.

HRSA-25-077 & HRSA-25-091 8

2. New THCs (new applications) – New residency program applicants must demonstrate the need for the number of resident FTE(s) being requested and that the number of resident FTEs being requested is above the program’s baseline. The baseline is the number of resident FTEs trained by the program in AY 2023-2024 for HRSA-25-091 and the number of resident FTEs trained by the program in AY 2024-2025 for HRSA-25-077.

New applicants may request THCGME support for resident FTEs if the requested resident FTEs are not supported by other funding sources by the period of performance start date (HRSA-25-091 November 1, 2024 and HRSA-25-077 July 1, 2025).

a. If applying for HRSA-25-091 training of newly supported THCGME residents must start in AY 2024-2025

b. If applying for HRSA-25-077 training of newly supported THCGME residents must start in AY 2025-2026.

Please note that a New THC is a “new approved graduate medical residency training program” as defined in section 340H(j)(2) of the PHS Act [42 U.S.C. 256h(j)(2)]) sponsored by an eligible entity that has not received a payment under the HRSA THCGME Program for a previous fiscal year for the residency training program in consideration.

Program requirements and expectations

• Reconciliation - All HRSA THCGME funding is subject to annual reconciliation. During reconciliation, any changes to the number of resident FTEs reported by the award recipient will be calculated to determine a final amount payable for the budget period. Recipients must ensure FTE accuracy for HRSA and may face audits. Recipients must coordinate with teaching hospitals to avoid over-reporting FTEs for THCGME Program funding. Over-reporting could result in overpayment, and any overpayment will be recouped.

• Other Funding Sources - THCGME Program funds must be used for program activities and may not replace or supplant funds that have been provided from a different source (e.g., a federal, state, local, tribal, non-profit, or for-profit entity) for the same resident FTE’s slot(s).

Such replacement or supplanting may be grounds for suspension or termination of current and future federal awards, recovery of misused federal funds, and/or other remedies available by law.

• Coordinate to prevent overpayment - THCGME Payments Relationship to Other Federal GME Payment Programs: Section 340H(e) of the PHS Act [42 U.S.C. 256h(e)] describes the relationship between THCGME Program funding and GME payments made by Medicare and the Children's Hospitals Graduate Medical Education (CHGME) Program. THCGME programs must coordinate closely to avoid overpayment for the same resident FTE time.

HRSA-25-077 & HRSA-25-091 9

• A THCGME-affiliated teaching hospital may receive Centers for Medicare & Medicaid Services (CMS) IME payments, CHGME IME payments, and/or CMS/CHGME DME) claims for a THCGME-funded resident FTE in which no actual payment is received from CMS.

• A THCGME-affiliated teaching hospital that receives additional CMS DME payments or CHGME DME payments for the same THCGME resident’s FTE time, will lead to the THCGME payment being reduced by the amount of DME received by the recipient.

• Other funding sources, such as state funding, grants, and endowments, must not overlap with THCGME-supported activities.

• Accreditation/Institutional Sponsorship - The eligible community-based ambulatory patient care center or GME consortium must be accredited in one of the primary care specialties/disciplines listed in the Eligibility section above and must be listed as the institutional sponsor by the relevant accrediting body (i.e., the Accreditation Council for Graduate Medical Education (ACGME) or the American Dental Association’s Commission on Dental Accreditation (CODA)) and named on the program’s relevant accreditation documentation.

• Applicants must maintain their accreditation throughout the award period of performance.

• In the event of an organizational change (program directors, sponsoring institutions, etc.), recipients must notify HRSA and submit a prior approval request for the change through HRSA Electronic Handbooks (EHB) system.

Funding policies & limitations

Policies

• Support beyond the first budget period will depend on:

- Appropriation of funds

- Satisfactory progress in meeting the project’s objectives.

- A decision that continued funding is in the government’s best interest.

Program-specific limitations

• Payments made through this announcement are to only be used for the direct expenses associated with sponsoring an approved graduate medical residency training program and indirect expenses associated with the additional costs relating to teaching residents in residency training programs.

HRSA-25-077 & HRSA-25-091 10

• THCGME Program funds may not be used for residency program development (e.g., the costs associated with accreditation).

See Manage Your Grant for other information on costs and financial management.

THCGME Program Payment Overview

• Current per resident amount for FY 2025: $160,000 per resident FTE

• Payments support both DME and IME

The FY 2025 HRSA THCGME Program payment is formula-based and provides a payment for both DME and IME expenses. The FY 2025 per resident amount will be $160,000 per resident

FTE.

Future per resident amounts may vary based on funding and changes as determined appropriate by the Secretary.

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered

Find the application package

Application writing help

HRSA-25-077 & HRSA-25-091 12

Get registered

SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

Grants.gov You must also have an active account with Grants.gov. You can see step-by step instructions at the Grants.gov Quick Start Guide for Applicants.

Need Help? See Contacts & Support.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-25-091 and HRSA-25-077.

After you select the opportunity, we recommend that you click the “Subscribe” button to get updates.

Application writing help Visit HHS’ Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

Join the webinar We will hold a pre-application technical assistance (TA) webinar. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website to learn more about the resources available for this funding opportunity.

https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bhw.hrsa.gov/fundingopportunities/default.aspx

Step 3:

Write Your Application

In this step

Application contents & format

HRSA-25-077 & HRSA-25-091 14

Application contents & format Applications include 5 main components. This section includes guidance on each.

There is a 60-page limit for the overall application.

Submit your information in English and express budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission Form Included in the page limit?

Project abstract Use the Project Abstract Summary Form. No

Project narrative Research and Related Other Project Information Yes

Budget narrative Use the Research and Related Budget Form. (Line L) Yes

Attachments Insert each in the Other Attachments form. Yes, unless otherwise marked below.

Other required forms Upload using each required form. Indicated in the other required forms section.

See the application checklist for a full list of all application requirements. See form instructions for more detail on completing each form.

Required format You must format your narratives and attachments using our required formats for fonts, size, margins, etc. See the formatting guidelines in section 4.2 of the R&R Application Guide

Project abstract Complete the information in the Project Abstract Summary Form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. When applicable, identify if you are requesting a funding priority or preference. For more information, see section 4.1.ix of the R&R Application Guide.

The Abstract must also include:

1. Name of the graduate medical training program;

2. Discipline of the residency program;

3. Type of application—Expansion or New;

4. Eligible Entity type;

• State the type and name of community-based ambulatory patient care center based on Eligible Entities, and

• Whether the community-based ambulatory patient care center operates the residency program alone or as part of a GME consortium.

https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=1

HRSA-25-077 & HRSA-25-091 15

5. Year program first began training residents;

6. Organization website address;

7. A brief overview of the residency program that includes the name of the accredited sponsoring institution (as designated by ACGME or CODA) and description of the main primary care training location including populations served;

8. Total resident FTE positions requested to be funded under this program for all post-graduate years of training, e.g., 12 (4-4-4) resident FTE above the baseline resident FTEs trained by the program in the prior AY;

• If applying for HRSA-25-091 use AY 2023-2024.

• If applying for HRSA-25-077 use AY 2024-2025.

9. Resident FTE positions requested to be funded under this program for the first AY of funding, e.g., 4 (4-0-0); and

• If applying for HRSA-25-091 use AY 2024-2025.

• If applying for HRSA-25-077 use AY 2025-2026.

10. Rotation Sites: State if residents within the applicant residency program will perform rotations at a hospital rotation site(s) that has not provided resident training in any prior

AY.

Project narrative In this section, you will describe all aspects of your project. Use the section headers and the order below.

Introduction & purpose See merit review criterion 1: Purpose & need

• Briefly describe the purpose and mission of your residency program.

Need See merit review criterion 1: Purpose & need

• Describe the trainees and their unmet needs this program will address. Trainees include residents and fellows participating in the residency program.

• Discuss any relevant barriers to trainees’ access to education and success in your program.

These barriers might include physical health, psychological health, physical environment, social environment, and economic stability.

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• Describe the population served by the community-based ambulatory patient care center(s) that will host the residency program.

• Identify any rural and/or underserved populations that will be served through this project.

• Describe how your residency program is expected to improve the workforce and improve health in your community.

• State the number of resident FTE(s) you are requesting for THCGME support.

• Use and cite demographic data whenever possible.

Approach See merit review criterion 2: Response

• Provide documentation in Attachment 1 and describe your current accreditation status:

• If applying for HRSA-25-091. Your residency program must already have current accreditation.

• If applying for HRSA-25-077. If your residency program is in the process of obtaining accreditation and/or approval from the relevant accrediting body to expand the number of accredited positions within the program, describe the progress the program has made toward achieving accreditation and/or approval to expand residency training by the June 1, 2025 deadline specified in this NOFO.

• If your residency program has not yet begun training residents (i.e., currently has a baseline of zero (0) residents), describe the steps that you have taken to ensure that the program will be operational in AY 2025-2026.

• Tell us how you’ll address your stated needs and meet the program requirements and expectations described in this NOFO.

• Describe your residency program education and training curriculum, including how your program will prepare graduates for primary care careers in rural and underserved areas.

• Highlight any unique aspects of training at the program, including any training in the following areas: high-need communities or populations served by the program, mental health, substance/opioid use disorders, public health, community medicine, rural health, and telehealth.

• Describe the clinical capacity of your community-based ambulatory patient care center and training partners to meet accreditation requirements.

• Describe your plans to recruit high quality residents who demonstrate a commitment to practice in rural and underserved communities and to develop competencies to serve diverse populations and communities, as described in the Introduction & purpose and Need sections.

HRSA-25-077 & HRSA-25-091 17

• For previously existing non-THCGME residency programs, describe historical program outcomes, including your program’s graduate retention and placement in Health Professional Shortage Areas (HPSAs), Medically Underserved Communities (MUCs), and/or rural areas.

• Include strategies for ongoing staff training, teamwork, and information sharing. Also include strategies for outreach and collaboration efforts to involve patients, families, and communities.

• Explain your strategies to improve trainees’ cultural competence to meet the needs of underserved communities. Include those that increase the use of culturally and linguistically appropriate services by providing training based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

• Include a plan to distribute reports, products, or project outputs to target audiences, as applicable.

• Describe the adequate facilities available to fulfill the needs of the proposed project.

High-level work plan See merit review criterion 2: Response

• Provide a detailed work plan that demonstrates your experience implementing a primary care residency program.

• Provide a timeline that includes each activity and identifies who is responsible for each.

Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application.

• Include the extent to which these stakeholders address the needs of the populations and communities served.

• Identify the extent to which these stakeholders have the necessary competencies to serve the cultural, linguistic, and/or geographic diversity of the relevant populations and communities.

• Explain your strategies to improve trainees’ cultural competence to meet the needs of underserved communities. This includes strategies that increase the use of culturally and linguistically appropriate services by providing training based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

HRSA-25-077 & HRSA-25-091 18

Resolving challenges See merit review criterion 2: Response

• Describe the obstacles and challenges the residency program may face during project implementation. Explain approaches that you’ll use to resolve them.

Performance reporting and evaluation See merit review criteria 3: Impact & 4: Resources & capabilit ies

• Performance Reporting. See THCGME Program Reporting Manual for performance measure requirements and examples of reporting forms.

• Describe how you will collect and report required performance data accurately and on time.

• Describe how you will manage and securely store data.

o Include how you will report National Provider Identifier (NPI) numbers for participants. Project trainees in eligible disciplines must apply for and report on an NPI.

• Describe your process to track practice patterns of trainees after program completion for up to 1 year.

o Include collecting trainees’ NPI.

• Describe how you will monitor and analyze performance data to support continuous quality improvement.

• Program Evaluation. The evaluation should examine processes and progress towards the goal, program objectives, and expected outcomes. Evaluations must follow the HHS Evaluation Policy, as well as the standards and best practices described in OMB Memorandum M-20-12. Describe your plan to evaluate the project. Include:

• The evaluation questions, methods, data to be collected, and timeline for implementation.

• The evaluation barriers and your plan to address them.

• The evaluation capacity of your organization and staff. Include experience, skills, and knowledge.

• How you will disseminate results, how you will assess whether your dissemination plan is effective, whether the results are national in scope, and the extent of potential replication.

• See Reporting for more information.

https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualhtmL.aspx?FormCode=1&IsPM=True&EHBActivityCode=T9C

HRSA-25-077 & HRSA-25-091 19

Sustainability See merit review criterion 3: Impact

We expect you to sustain key project elements that improve practices and outcomes for the target population. Propose a plan for project sustainability after the period of federal funding ends.

• Describe the actions you’ll take to:

- Highlight key elements of your projects. (Examples include training methods or strategies that have been effective in improving practices.)

- Obtain future sources of funding.

- Determine the timing to become self-sufficient.

• Discuss challenges that you’ll likely encounter in sustaining the program. Include how you will resolve these challenges.

Organizational information See merit review criterion 4: Resources & capabilit ies

Briefly describe your mission, structure, and the scope of your current activities. Explain how they support your ability to carry out the program requirements. Include a project organization chart.

• Discuss how you’ll follow the approved plan, account for federal funds, and satisfy reporting requirements to avoid audit findings.

• Describe how you’ll assess the unique needs of the trainees you serve.

• Describe the organizations you will partner with to fulfill the program goals and meet the training objectives. Include all members of any consortium, how finances will be managed and what role each member plays, along with key agreements Attachment 3 and letters of support Attachment 8.

• For GME consortiums, explain how the community-based ambulatory patient care center will receive direct funds through the consortium and how it is a significant member of the consortium (e.g., its role in the selection of trainees and faculty and the development of rotation schedules and curriculum.) Describe how residency program partner training sites will get funds.

• Include a staffing plan and job descriptions for key faculty and staff in Attachment 4.

• Include biographical sketches, not to exceed TWO pages in length, for key staff using the Research & Related Senior/Key Person Profile form. See Standard Forms.

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Budget & budget narrative See merit review criterion 5: Support requested

The THCGME Program is a formula-based payment program that does not require submission of a formal budget.

A Resident FTE Request Justification for the number of resident FTEs requested is required.

Resident FTE Request Justification The number of resident FTEs requested will determine your THCGME funding amount. You must provide a justification for the number of resident FTEs you are requesting, see Research and Related Budget Form section L for upload instructions.

Describe how the additional FTEs will address the needs of your program and the community your program serves.

A strong justification will be supported by data and examples, account for accreditation requirements, and be directly related to the Introduction & Purpose and Need sections.

• Resident FTE requests should align with the documentation provided in the Eligible Resident/Fellow FTE Chart Attachment 5.

• For existing HRSA-funded THCs requesting expansion of resident FTEs, the resident FTE number requested should be above the number stated in your most recent HRSA THCGME Program Resident FTE Approval Letter.

• For existing non-HRSA funded THCs, the resident FTE number requested should be above your reported and attestation confirmed number of baseline FTE slots.

Attachments Place your PDF attachments in order in the Other Attachments form.

Attachment 1: Accreditation documentation Required - Counts toward page limit .

You must provide documentation of your residency accreditation, or probationary accreditation from the appropriate accrediting body (ACGME or CODA). Please do not provide only the web link to the accreditation body’s website. HRSA will not open any links included in the application.

Documentation must clearly identify the residency program’s institutional sponsor, number of approved resident positions, dates of accreditation, and any noted citations (if applicable).

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Applicants that are in the process of obtaining accreditation must provide documentation from the appropriate accrediting body demonstrating that the accreditation process has been initiated prior to the application due date.

• If applying for HRSA-25-091. Note that documentation of accreditation must be provided with application for the applicant to be considered eligible through this announcement.

• If applying for HRSA-25-077. Note that documentation of accreditation must be received by HRSA by no later than June 1, 2025, for the applicant to be considered eligible through this announcement.

Applicants will not receive THCGME Program funds if documentation of accreditation is not received by HRSA by the deadlines specified above. Relevant accreditation application documentation should be included if an application is pending.

Attachment 2: Residency program organizational chart Required - Counts toward page limit .

Provide a one-page figure that shows the organizational structure of the residency program, including the community-based ambulatory patient care center and all major training partners.

Attachment 3: Letters of agreement, memoranda of understanding, and contracts As Applicable - Counts toward page limit .

Provide any documents that describe working relationships between your organization and other organizations and programs you cite in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe the roles of the contractors and partners and any deliverables. Make sure any letters of agreement are signed and dated. If letters of support are required for eligibility, include in this attachment.

Letters of agreement from hospital training partners must address understanding and steps to ensure that THCGME resident FTEs will not also be submitted to Medicare GME or CHGME Program for the purposes of receiving GME payments.

Affiliation agreements with CMS-naïve hospitals, defined as hospitals that have not previously trained medical residents, must include acknowledgement that new residents rotating at these sites will trigger the CMS resident FTE cap-building period.

NOTE: Abbreviated/shortened documentation of relevant Letters of Agreement, Memoranda of Understanding, and/or Description of Proposed/Existing Contracts is acceptable to accommodate the page limit noted in this NOFO.

Documentation provided should be clear, concise, and address all requirements described above.

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Attachment 4: Staffing plan & job descriptions for key personnel Required - Counts toward page limit .

See Section 4.1.vi of the R&R Application Guide.

Include a staffing plan that shows the staff positions that will support the project and key information about each. Justify your staffing choices, including education and experience qualifications.

For key personnel, attach a one-page job description. It must include the role, responsibilities, and qualifications.

Attachment 5: Eligible Resident/Fellow FTE Chart As Applicable - Counts toward page limit .

Upload a copy of the completed Eligible Resident/Fellow FTE Chart.

• If applying for HRSA-25-091: The chart must include the total resident training numbers from the previous five academic years (if applicable), proposed total resident training numbers for AY 2024-2025 through AY 2028-2029, and requested THCGME resident FTE for AY 2024-2025 through AY 2028-2029.

• If applying for HRSA-25-077: The chart must include the total resident training numbers from AY the previous five academic years (if applicable), proposed total resident training numbers for AY 2025-2026 through AY 2028-2029, and requested THCGME resident FTE for AY 2025-2026 through AY 2028-2029.

Please see Appendix B for the OMB-approved form and the form completion instructions.

Limitations apply to resident FTEs that can be submitted for THCGME payments.

Attachment 6: Funding priority documentation As Applicable- Counts toward page limit .

Provide documents that prove you qualify for the funding priority.

See Selection Process for information about how these apply.

Attachment 7: Proof of nonprofit status As Applicable- Does not count toward in the page limit .

If your organization is a non-profit, you need to attach proof. We will accept any of the following:

• A copy of a current tax exemption certificate from the Internal Revenue Service (IRS).

HRSA-25-077 & HRSA-25-091 23

• A letter from your state's tax department, attorney general, or another state official saying that your group is a non-profit and that none of your net earnings go to private shareholders or others.

• A certified copy of your certificate of incorporation. This document must show that your group is a non-profit.

• Any of the above for a parent organization. Also include a statement signed by an official of the parent group that your organization is a non-profit affiliate.

Attachment 8: Letters of Support As Applicable - Does not count toward the page limit .

Provide a letter of support for each organization or department involved in your proposed project. Letters of support must be from someone who holds the authority to speak for the organization or department (e.g., CEO, Chair, etc.), must be signed and dated, and must specifically indicate understanding of the project and a commitment to the project, including any resource commitments (e.g., in-kind services, dollars, staff, space, equipment, etc.).

Attachment 9: THCGME Program Assurances As Applicable - Does not count toward the page limit .

Provide THCGME Program information on resident FTE time that qualifies to receive THCGME payments. You must submit a signed THCGME Program Assurances document confirming that you have reviewed and will comply. Please see Appendix A for instructions.

Attachment 10: Documentation of Resident FTE Eligibility As Applicable - Does not count toward the page limit .

Provide documentation that the funds for the resident FTE slots you are requesting will not replace funds that have been provided from a different source for the same resident FTEs (e.g., in-kind, federal, state, local, tribal, non-profit or for-profit entity).

If applicable, provide documentation certifying that you have lost or will lose support for these requested positions by the November 1, 2024 (HRSA-25-091) or July 1, 2025 (HRSA-25-077), the project start dates.

Attachment 11-15: Other Relevant Documents As Applicable - Does not count toward the page limit .

Include here any other document that is relevant to the application.

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Other required standard forms You will need to complete some other forms. Upload the forms listed below at Grants.gov. You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms. See the application checklist for a full list of all application requirements.

* Only what you attach in addition to these forms counts against the page limit. The form itself does not count.

Form instructions

SF-424 R&R Form Does not count against the page limit

Follow the instructions in section 4.1 of the R&R Application Guide.

Research and Related Other Project Information Only the project narrat ive counts against the page limit

In addition to the requirements in the project narrative section, you will provide some additional information in this form.

• Complete sections 1 through 6.

• Upload a blank document in item 7: Project Summary/Abstract to avoid a cross-form error with your Project Abstract Summary Form.

• Upload your project narrative in item 8.

• Leave items 9, 10, and 11 blank.

Research and Related Senior/Key Person Profile (Expanded) Form Does not count against the page limit

In addition to the requirements in Organizational Information, follow these instructions.

Forms Submission Requirement

SF-424 R & R (Application for Federal Assistance) Form

Yes, with application.

Research and Related Other Project Information Yes, with application.

Research and Related Senior/Key Person Profile (Expanded) Form

Yes, with application.

Research and Related Budget Form Yes, with application.

R & R Subaward Budget Attachment(s) Form Not applicable, with application.

Project/Performance Site Locations(s) Form Yes, with application.

Disclosure of Lobbying Activities (SF-LLL) Form If applicable, with the application or before the award.

https://www.grants.gov/forms

HRSA-25-077 & HRSA-25-091 25

• Include biographical sketches for people who will hold the key positions.

• Try to use no more than two pages in length per person.

• Do not include personally identifiable information (i.e. social security number, personal address, phone number, etc).

• If you include someone you have not hired yet, include a letter of commitment from that person with their biographical sketch.

• Upload sketches in this form.

• Include:

- Name and title

- Education and training – for each entry include Institution and location, degree and date earned, if any, and field of study.

- Section A, Personal Statement. Briefly describe why the individual’s experience and qualifications make them well-suited for their role.

- Section B, Positions and Honors. List in chronological order previous and current positions. List any honors. Include present membership on any federal government public advisory committee.

- Section C, Other Support. This section is optional. List selected ongoing and completed projects during the last three years. Begin with any projects relevant to the proposed project. Briefly indicate the overall goals of the projects and responsibilities of the person.

- Other information. If they apply, include language fluency and experience working with populations that are culturally and linguistically different from their own.

Please note, the R&R Application Guide states that biographical sketches count toward the page limit. However, for this Notice of Funding Opportunity, your biographical sketches will not count toward the page limit.

Research and Related Budget Form Only the Resident FTE Request Just if icat ion counts against the page limit

Your application package contains a required R&R Budget Form.

• Input zeros in blocks A-K.

• Use block L. Budget Justification -Attach the Resident FTE Request Justification to the SF- 424 R&R Budget Form.

R & R Subaward Budget Attachment(s) Form Not applicable

HRSA-25-077 & HRSA-25-091 26

Project/Performance Site Location(s) Form Counts against the page limit*

Follow the form instructions in Grants.gov

Disclosure of Lobbying Activities (SF-LLL) Form Does not count against the page limit

Follow the form instructions in Grants.gov.

Step 4:

Learn About Review & Award

In this step

Application review

Award notices

HRSA-25-077 & HRSA-25-091 28

Application review

Initial review We review each application to make sure it meets basic requirements. We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Is submitted after the deadline.

• Does not include the appropriate tables.

• Fails to include all required documents

• Requests funding for residency programs in specialties/disciplines outside of those listed in the Eligibility section or that have not obtained accreditation by the project start date.

Also, we will not review any pages over the page limit.

Merit review A panel reviews all applications that pass the initial review. The members use the criteria below.

Criterion Total number of points = 100

1. Purpose & need 20 points

2. Response 35 points

3. Impact 15 points

4. Resources & capabilities 20 points

5. Support requested 10 points

Criterion 1: Purpose & need 20 points

See Project Narrative, Introduction & purpose, and Need sections.

The panel will review your application for how well it:

• Describes the purpose and mission of your residency program.

• Describe the trainees and their unmet needs this program will address. Trainees include residents and fellows participating in the residency program.

HRSA-25-077 & HRSA-25-091 29

• Discuss any relevant barriers to trainees’ access to education and success in your program.

These barriers might include physical health, psychological health, physical environment, social environment, and economic stability.

• Describe the population served by the community-based ambulatory patient care center(s) that will host the residency program.

• Identify any rural and/or underserved populations that will be served through this project.

• Describe how your residency program is expected to improve the workforce and improve health in your community.

• State the number of resident FTE(s) you are requesting for THCGME support.

• Use and cite demographic data whenever possible.

Criterion 2: Response 35 points

See Project Narrative Approach, High-level work plan, and Resolving challenges sections.

Approach (20 points).

The panel will review your application for how well it:

• Proposes a detailed work plan that demonstrates your experience implementing a primary care residency care program.

• Describes and provides evidence of its accreditation status.

o If applying for HRSA-25-077: Residency programs that have not yet begun training residents, must describe steps that they have taken to ensure the program will be operational in AY 2025-2026.

• Describes its residency program education and training curriculum, including plan to prepare graduates for primary care careers in rural and underserved areas.

• Highlights any unique aspects of training at the program, including any training in the following areas:…