BHW HRSA-22-042 (D34) COE_Final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Health Careers and Financial Support

Centers of Excellence (COE)

Funding Opportunity Number: HRSA-22-042

Funding Opportunity Type(s): New, Competing Continuation

Assistance Listings (AL/CFDA) Number: 93.157

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: January 31, 2022

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: November 2, 2021

Tammy Mayo-Blake, M.Ed.

Education Program Specialist Telephone: (301) 443-0827 Email: tmayo-blake@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 293 (Public Health Service Act, Title VII, Section 736).

mailto:tmayo-blake@hrsa.gov

HRSA-22-042 i

508 Compliance Disclaimer

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

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Centers of Excellence Program (COE).

The purpose of this program is to strengthen the nation’s capacity to produce a diverse, culturally competent health care workforce. COE will provide funding for innovative resource and education centers to recruit, train, and retain under-represented minority students and faculty at health professions schools.

Section 736 of the Public Health Service (PHS) Act authorizes funding for education and training enhancement programs to increase opportunities for under-represented minority individuals to enter and successfully complete a health professions academic program.

Funding Opportunity Title: Centers of Excellence (COE) Funding Opportunity Number: HRSA-22-042 Due Date for Applications: January 31, 2022 Anticipated Total Annual Available FY 2022 Funding:

$10,300,000

Estimated Number and Type of Award(s): Up to 15 grants Estimated Annual Award Amount: Approximately $686,000 per award, subject to the availability of appropriated funds

Cost Sharing/Match Required: No Period of Performance: July 1, 2022 through June 30, 2027

(5 years)

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Eligible Applicants: Accredited allopathic schools of medicine, osteopathic medicine, dentistry, pharmacy, and graduate programs in behavioral or mental health that meet the requirements of Section 736(c) of the PHS Act. The four designated Historically Black Colleges and Universities (HBCUs) listed in Section 736 are not eligible for this NOFO; they are eligible to compete under a separate NOFO to be issued in

FY 2023.

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) 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 at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx iii

HRSA-22-042

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Standardized Work Plan (SWP) Form

vi. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Centers of Excellence (COE) Program.

Program Purpose

The COE was established to be a catalyst for institutionalizing a commitment to under-represented minority (URM) students and faculty. Part of this commitment includes providing educational and training opportunities that focus on increasing racial and ethnic diversity among health professions and addressing minority health issues.

COE grantees serve as innovative resources and education centers to recruit, train, and retain URM students and faculty at health professions schools. Programs improve information resources, clinical education, curricula, and cultural competence as they relate to minority health issues and social determinants of health. COE grantees also focus on facilitating faculty and student research on health issues particularly affecting URM groups.

Program Goals

1) To strengthen the national capacity to produce a quality health care workforce with racial and ethnic diversity to improve the quality and delivery of health care through collaborations and strategic partnerships.

2) To serve as innovative, education resource centers to recruit, train, and retain URM students and faculty at health professions schools.

3) To improve clinical education and cultural competence for minority health issues and social determinants of health.

4) To facilitate faculty and student research on health issues particularly affecting under-represented minority groups, including research on issues relating to the delivery of health care.

Program Objectives

• Develop a large competitive URM applicant pool through linkages with institutions of higher education, local school districts, and other community-based entities to establish an education pipeline for health professions careers;

• Establish, strengthen or expand structured programs to enhance URM student academic performance;

• Develop structured programs to improve the capacity of the school for recruitment, training and retention of URM faculty, including the payment of stipends and fellowships;

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• Develop activities to improve the school’s information resources, clinical education, curricula and cultural competence as it relates to minority health issues;

• Facilitate faculty and student research on health disparities that disproportionately affect URM groups, including research on issues relating to the delivery of health care and health equity;

• Develop structured programs to train URM students in providing health care services to a significant number of URM individuals at community-based settings providing such health services and sites remote from the main site of the teaching facilities of the school; and

• Provide stipends to URM students participating in structured programs.

Applicants can find additional information on HRSA’s pipeline programs at https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/health-careers-pipeline-and-diversity-2018.pdf.

General Emergency Preparedness Statement Eligible entities must be ready to continue programmatic activities in the event of a public health emergency – both those that are expected and unexpected.

A training-focused emergency preparedness plan is critical for HRSA-funded projects and helps ensure that grantees are able to continue programmatic activities, can coordinate effectively, and can implement recovery plans when emergencies disrupt project activities. Applicants must develop and maintain a flexible training-focused emergency preparedness plan in case of public health emergencies to ensure continuation of programmatic and training activities, including but not limited to didactic, experiential and clinical training.

2. Background

The Centers of Excellence program is authorized by PHS Act, Title VII, Section 736, as amended by the Coronavirus Aid, Relief and Economic Security Act (CARES Act), P. L.

116-136.

The 2019 U.S. Census Bureau indicated that approximately 40 percent of the U.S.

population is made up of racial and ethnic minorities.1 With national population projections estimating that ethnic minorities will account for almost half of the U.S.

population by 2060,2 a need to diversify the health care workforce has become increasingly important. Research shows that a representative health workforce is linked

1 Quick Facts, US Census Bureau, July 2019, available at https://www.census.gov/quickfacts/fact/table/US/PST045219 2 Vespa J., Medina L. & Armstrong D. M. (2020). Demographic Turning Points for the United States:

Population Projections for 2020 to 2060. U.S. Census Bureau.

https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/health-careers-pipeline-and-diversity-2018.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/health-careers-pipeline-and-diversity-2018.pdf https://www.census.gov/quickfacts/fact/table/US/PST045219

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to increased cultural competence, quality of care, and better health outcomes. However, despite ongoing efforts to diversify the growing health care field, minority groups continue to be under-represented across health professions.3

Over the last few years, policy efforts to promote a health care workforce representative of the U.S. demographics have been in place. Data shows that while diversity among health professions graduates has increased compared to the current workforce, representation is still not equivalent to the general U.S. population. For nearly two decades, for example, medical school enrollment of blacks and Native Americans has remained in the 7 percent and 1 percent range.4 Similar enrollment trends have been identified in nursing school programs,5 while dental and physician assistant schools have experienced a decline in the enrollment of URM over the last decade.6,7 Moreover, most of the health fields that have seen an increase in minority representation tend to be entry or junior level positions with few opportunities for advancement.8

Many URM students also lack access to employment opportunities and career advancement in the health sector. The current shortage of URM providers, particularly in rural and underserved communities, brings new urgency to this labor market challenge. Consistent with the COE requirement to bring health professions students into community- based health facilities, developing and building strategic partnerships with business and health care employers will allow COE grantees the opportunity to transition their students into higher wage positions and career advancement. Ultimately, these new health professionals will drive innovative and creative solutions to improve the economic outcomes of rural and underserved communities.

Studies have tried to identify factors causing the consistently slow enrollment of URM students into undergraduate and graduate health programs and related lower numbers of URM becoming health professionals. Socioeconomic status, family dynamics, lack of mentorship, high tuition costs, standardized tests, and inadequate representation are

3 Wilbur, K., Snyder, C., Essary, A. C., Reddy, S., Will, K. K., & Mary Saxon. (2020). Developing Workforce Diversity in the Health Professions: A Social Justice Perspective. Health Professions Education, 6(2), 222–229.

https://doi.org/10.1016/j.hpe.2020.01.002 4 Rodriguez, J. E., Campbell, K. M., & Adelson, W. J. (2015). Poor representation of Blacks, Latinos, and Native Americans in medicine. Family Medicine, 47(4), 259–263.

5 Brooks Carthon, J. M., Nguyen, T.-H., Chittams, J., Park, E., & Guevara, J. (2014). Measuring success:

Results from a national survey of recruitment and retention initiatives in the nursing workforce. Nursing Outlook, 62(4), 259–267. https://doi.org/10.1016/j.outlook.2014.04.006 6 Coplan, B., Bautista, T. G., & Dehn, R. W. (2018). PA program characteristics and diversity in the profession. Journal of the American Academy of Physician Assistants, 31(3), 38–46.

https://doi.org/10.1097/01.JAA.0000530295.15656.51 7 Mertz, E. A., Wides, C. D., Kottek, A. M., Calvo, J. M., & Gates, P. E. (2016). Underrepresented Minority Dentists: Quantifying Their Numbers And Characterizing The Communities They Serve. Health Affairs, 35(12), 2190–2199. https://doi.org/10.1377/hlthaff.2016.1122 8 See footnote 3.

https://doi.org/10.1016/j.hpe.2020.01.002 https://doi.org/10.1016/j.outlook.2014.04.006 https://doi.org/10.1097/01.JAA.0000530295.15656.51 https://doi.org/10.1377/hlthaff.2016.1122

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among the most influential determinants.9,10 According to a national study, 31 percent of college students who worked and received financial aid still reported food and housing insecurities.11 Without financial security, it can be challenging for minority students to complete an undergraduate program and all the prerequisites needed to apply for a graduate health degree. Studies have also determined that representative faculty in health professions schools can diversify mentorship programs and promote the participation of URM students.12 However, less than 10 percent of faculty in health professions schools and research programs identify as coming from URM background.13,14

The COE Program was established to be a catalyst for institutionalizing a commitment to URM students and faculty. Part of this commitment includes providing education and training opportunities that focus on increasing racial and ethnic diversity among health professionals and addressing minority health issues. The COE Program provides grants to health professions schools, and other public and private nonprofit health or educational entities, to recruit, train and retain URM students and faculty. These award recipients also focus on facilitating faculty and student research on health issues, particularly those affecting URM groups, including issues that relate to the delivery of health care.

The COE Program has made significant contributions to health workforce development, more specifically as it relates to diversity in the workforce and providing culturally competent health care. In Academic Year 2019-2020, the COE Program supported 141 training programs that carried out activities designed to prepare URM individuals either to apply to a health professions training program or to maintain enrollment in such programs during the academic year. Award recipients developed programming focused on mentorship and academic support and URM faculty recruitment and development. A total of 3,246 students completed COE programming, with 1,359 receiving stipend support. Ninety-nine percent of those receiving stipend support were considered URMs

9 Vishwanatha, J. K., Basha, R., Nair, M., & Jones, H. P. (2019). An Institutional Coordinated Plan for Effective Partnerships to Achieve Health Equity and Biomedical Workforce Diversity. Ethnicity & Disease, 29(Suppl 1), 129–134. https://doi.org/10.18865/ed.29.S1.129 10 Baugh, A. D., Vanderbilt, A. A., & Baugh, R. F. (2019). The Dynamics of Poverty, Educational Attainment, and the Children of the Disadvantaged Entering Medical School. Advances in Medical Education and Practice, Volume 10, 667–676. https://doi.org/10.2147/AMEP.S196840 11 Vishwanatha, J. K., & Jones, H. P. (2018). Implementation of the Steps Toward Academic Research (STAR) Fellowship Program to Promote Underrepresented Minority Faculty into Health Disparity Research. Ethnicity & Disease, 28(1), 3. https://doi.org/10.18865/ed.28.1.3 12 See footnote 9.

13 Hagan, A. M., Campbell, H. E., & Gaither, C. A. (2016). The Racial and Ethnic Representation of Faculty in US Pharmacy Schools and Colleges. American Journal of Pharmaceutical Education, 80(6),

108. https://doi.org/10.5688/ajpe806108 14 See footnote 3.

https://doi.org/10.18865/ed.29.S1.129 https://doi.org/10.2147/AMEP.S196840 https://doi.org/10.18865/ed.28.1.3 https://doi.org/10.5688/ajpe806108

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in the health professions. In addition, 72 percent of all trainees were from financially and/or educationally disadvantaged backgrounds.15

Data shows that health professionals who identify as URM, or who have been mentored by URM faculty, are more likely to practice in primary care and serve in underserved communities.16 Efforts to promote a diverse health workforce through programs that enhance educational opportunities for URM students are key to improve access to care, strengthen patient-centered services and reduce health disparities, including mental health disparities. COE grantees partnered with 216 health care delivery sites to provide 3,728 clinical training experiences to health professions trainees. Approximately 30 percent of training sites used by COE grantees were in primary care settings and 43 percent were in Medically Underserved Communities (MUCs).

Despite strong evidence supporting the value of having a diverse health care workforce representative of the communities it serves, many groups are under-represented across the health professions, including mental and behavioral health.17

This situation is exacerbated by an increasing need for mental and behavioral health services in MUCs and rural areas. In order to achieve the goal of high quality, safe, and accessible care, there may be a growing need for the mental and behavioral health workforce to reflect the makeup of the general population.18 Successfully addressing inequities in representation within health care occupations, including those in mental and behavioral health, requires efforts to both recruit and retain URM students through financial and other supports necessary to help them enter and succeed in their health careers.19

Success in the health careers includes preparing future providers to be resilient. Health professions educational institutions, affiliated clinical training sites, accreditors, and related external organizations have a responsibility to create and maintain positive learning environments that support the professional development and well-being of students and trainees. Evidence indicates that there is a need to promote professional well-being and address burnout early in professional development. Numerous studies have found a high prevalence of burnout among students in medical schools. Estimates from a comprehensive narrative review of articles about medical student burnout (1990– 2015) found that 35 to 45 percent of medical students had high emotional exhaustion, 15 U.S. Department of Health and Human Services. Health Resources and Services Administration.

Report to the House Senate Committees on Appropriations – Diversity Programs and Mental Health Disparities.

16 See footnote 16.

17 Identifying Behavioral Health’s Workforce Diversity Issue, How to Fix It, August 31, 2021, Behavioral Health Business https://bhbusiness.com/2021/08/31/identifying-behavioral-healths-workforce-diversity-issue-how-to-fix-it/ 18 Olfson, M. (2016). Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses, V.35, No 6. https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1619 19 See footnote 16.

https://bhw.hrsa.gov/health-workforce-analysis/research/projections/behavioral-health-workforce-projections https://bhbusiness.com/2021/08/31/identifying-behavioral-healths-workforce-diversity-issue-how-to-fix-it/ https://bhbusiness.com/2021/08/31/identifying-behavioral-healths-workforce-diversity-issue-how-to-fix-it/ https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1619

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26 to 38 percent had high depersonalization, and 45 to 56 percent had at least one symptom of burnout.20 Expansion of behavioral health programs will promote resilience and the integration of primary and behavioral health to better address the needs of individuals with mental health and substance use disorders and prevent and mitigate burnout among health professions students, trainees, and providers.21

While COE grantees have trained students in current and emerging health issues since its inception, the program seeks to address broader health disparities across the nation through the support of under-represented minority individuals in the health care workforce, including a focus on mental and behavioral health providers.

Program Definitions A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. In addition, the following definitions apply to the COE Program for FY 2022:

Disadvantaged Background: An individual from a disadvantaged background is defined as someone who comes from an environmentally or economically disadvantaged background.

Disparity Impact Statement: Applicants are expected to develop a disparity impact statement using local data (e.g., the CDC Social Vulnerability Index (SVI) [https://www.atsdr.cdc.gov/placeandhealth/svi/index.html]) to identify populations at highest risk for health disparities and low health literacy.22 The disparity impact statement will provide the framework for ongoing monitoring and determining the impact of the Centers of Excellence Program. Below are available HHS resources:

CMS.gov: Quality Improvement & Interventions: Disparity Impact Statement

SAMHSA.gov: Disparity Impact Statement

Environmentally disadvantaged: An individual comes from an environment that has inhibited him/her from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school.

20 National Academies of Sciences, Engineering, and Medicine. 2019. Taking action against clinician burnout: A systems approach to professional well-being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.

21 See footnote 20.

22 The National Institutes of Health have designated the following U.S. health disparity populations:

Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, Sexual and gender minorities, Socioeconomically disadvantaged populations, Underserved rural populations See National Institute on Minority Health and Health Disparities, Health Disparity Populations (April 1, 2021).

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.atsdr.cdc.gov/placeandhealth/svi/index.html https://www.cms.gov/About-CMS/Agency-Information/OMH/resource-center/hcps-and-researchers/quality-improvements-and-interventions https://www.samhsa.gov/grants/grants-management/disparity-impact-statement https://doi.org/10.17226/25521 https://www.nimhd.nih.gov/about/overview/ https://www.nimhd.nih.gov/about/overview/

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Economically disadvantaged: An individual comes from a family with an annual income below a level based on low-income thresholds, according to family size established by the U.S. Census Bureau, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary of the U.S. Department of Health and Human Services, for use in all health professions programs. The Secretary updates these income levels in the Federal Register annually.

The Secretary defines a ‘‘low income family/household’’ for various health professions programs included in Title VII of the PHS Act, as having an annual income that does not exceed 200 percent of the Department’s poverty guidelines. A family is a group of two or more individuals related by birth, marriage, or adoption who live together. A household may be only one person.

2021 HRSA Poverty Guidelines (200% of HHS Poverty Guidelines) Size of parents’ family*

Income Level** 48 Contiguous States and D.C.

Alaska Hawaii

1 $25,760 $32,180 $29,640 2 34,840 43,540 40,080 3 43,920 54,900 50,520 4 53,000 66,260 60,960 5 62,080 77,620 71,400 6 71,160 88,980 81,840 7 80,240 100,340 92,280 8 89,320 111,700 102,720 For each additional person, add

$9,080 $11,360 $10,440

* Includes only dependents listed on federal income tax forms. Some programs will use the student’s family rather than his or her parents’ family.

** Adjusted gross income for calendar year 2020.

SOURCE: Federal Register, Vol. 86, No. 41, March 4, 2021, 12698-12699.

The following are provided as examples of a disadvantaged background. These examples are for guidance only and are not intended to be all-inclusive. Each academic institution defines the below mentioned “low” rates based on its own enrollment populations. It is the responsibility of each applicant to clearly delineate the criteria used to classify student participants as coming from a disadvantaged background. The most recent annual data available for the last four examples below can be found on your state’s Department of Education website under your high school’s report card.

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• The individual comes from a family that receives public assistance (e.g., Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, Medicaid, and public housing).

• The individual is the first generation in his or her family to attend college.

• The individual graduated from (or last attended) a high school with low SAT scores, based on most recent annual data available.

• The individual graduated from (or last attended) a high school that—based on the most recent annual data available— had either allow percentage of seniors receiving a high school diploma; or low percentage of graduates who go to college during the first year after graduation.

• The individual graduated from (or last attended) a high school with low per capita funding.

• The individual graduated from (or last attended) a high school where—based on the most recent annual data available— many of the enrolled students are eligible for free or reduced-price lunches.

Equity: “[T]he consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons;

persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”23

Addressing issues of equity should include an understanding of intersectionality and how multiple forms of discrimination impact individuals’ lived experiences. Individuals and communities often belong to more than one group that has been historically underserved, marginalized, or adversely affected by persistent poverty and inequality.

Individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages, including in their access to needed services.24

Structured Program: Formal student or faculty development and enhancement programs of a specified length with a specially designed curriculum or set of activities in which designated students and faculty participate to enhance their academic performance and professional development. All structured programs should include:

• Stipend support

• Curricula that includes but is not limited to:

23 Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, 86 FR 7009, at § 2(a) (Jan. 20, 2021), https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf.

24 See Executive Order 13988 on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation, 86 FR 2023, at § 1 (Jan. 20, 2021), https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf.

https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01761.pdf

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o Preliminary education and health research trainings, such as standardized test preparatory training, study skills trainings, math and science enrichment courses; and o Health Research Training focused on health disparity issues, including research on issues related to the delivery of health care; and

• Specialized Training in:

o Primary care, community-based settings; and rural and medically underserved communities.

Underserved Communities: Populations sharing a particular characteristic, as well as geographic communities that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, as exemplified by the list in the preceding definition of equity.25

Underrepresented minority: , The term ‘‘underrepresented minorities’’ means, with respect to a health profession, racial and ethnic populations that are underrepresented in the health profession relative to the number of individuals who are members of the population involved. Asian individuals shall be considered by the various subpopulations of such individuals. Additionally, “Native Americans’’ means “American Indians, Alaskan Natives, Aleuts, and Native Hawaiians”.26 For purposes of this program, the definition of racial and ethnic groups underrepresented in the health profession can be found in the Health Workforce Glossary.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New, Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $10,300,000 to be available annually to fund 15 recipients. The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $686,000 total cost (includes both direct and indirect, facilities and administrative costs) per year.

25 Executive Order 13985, at § 2(b).

26 PHS Act Section 799B(10)(A)-(B), 736(g)(3) https://bhw.hrsa.gov/glossary

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This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is July 1, 2022 through June 30, 2027 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for the COE Program in subsequent fiscal years, satisfactory recipient progress, and a decision that continued funding is in the best interest of the Federal Government.

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

Limitations on indirect cost rates.

Indirect costs under training awards to organizations other than state or local governments, or federally recognized Indian tribes will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, as otherwise allowable, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

For the purpose of this NOFO, eligible applicants are accredited allopathic schools of medicine, osteopathic medicine, dentistry, pharmacy, and graduate programs in behavioral or mental health that meet the requirements of Section 736(c) of the PHS Act. The four designated Historically Black Colleges and Universities (HBCUs) listed in Section 736(c)(2) are not eligible for this NOFO; they are eligible to compete under a separate funding announcement to be issued in FY 2023. Other HBCUs not listed in Section 736(c)(2) are eligible to compete for this NOFO under the “Other COE” designation.

Designations of COE: Specific Conditions

Below are the specific eligibility requirements for designation as a COE in each of the COE categories:

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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A. Hispanic COE Programs:

To be eligible for designation as a Hispanic COE, the designated health professions school must meet the following conditions with respect to Hispanic individuals:

1. Have a significant number of Hispanic individuals enrolled in the school or discipline, including individuals accepted for enrollment at the school;

2. Have been effective in assisting Hispanic students of the school to complete the education program and receive the health professional degree involved;

The following table specifies the minimum graduation percentage of Hispanic students earning a health professions degree, which is required for a health professions school or graduate program in behavioral or mental health to qualify as a Hispanic COE applicant.

Health Professions School’s Eligibility for Hispanic COE

Health Professions School and Degree Minimum % of Hispanic

Student Graduates3 Schools of Dentistry (D.D.S., D.M.D.) 8.6 Allopathic/Osteopathic Schools of Medicine (M.D., D.O.) 8.8 Schools of Pharmacy (Pharm.D.) 5.2 Behavioral or Mental Health5 15.4

3. Have been effective in recruiting Hispanic individuals to enroll in and graduate from the school or discipline, including providing scholarships and other financial assistance to such individuals and encouraging Hispanic students from all levels of the educational pipeline to pursue health professions careers; and

4. Have made significant recruitment efforts to increase the number of Hispanic individuals serving in faculty or administrative positions at the school.

Further, an eligible entity for designation as a Hispanic COE must:

1. Agree that it will give priority to Hispanic individuals in carrying out the seven program objectives listed earlier in Section I.1;

2. Establish an arrangement with one or more public or nonprofit community-based Hispanic-serving organizations, or public or nonprofit private institutions of higher education, including schools of nursing, whose enrollment of students has traditionally included a significant number of Hispanic individuals, to help carry out the program to (a) identify Hispanic students who are interested in a career in the health professions involved and (b) facilitate the educational preparation these students to enter the health professions school; and

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3. Make efforts to recruit Hispanic students, including students who have participated in enhancement programs at the undergraduate level or other matriculation programs carried out under arrangements established by the school, and assist Hispanic students in completing the educational requirements for a degree from a designated school.

B. Native American COE Program:

To be eligible for designation as a Native American COE, the designated health professions school involved must meet the following conditions with respect to Native Americans:

1. Have a significant number of Native American individuals enrolled in the schools, including individuals accepted for enrollment at the school;

2. Have been effective in assisting Native American students of the schools to complete the program of education and receive the degree involved;

The following table specifies the minimum graduation percentage of Native American students earning a health professions degree, which is required for a health professions school or graduate program in behavioral or mental health, to qualify as a Native American COE program applicant.

Health Professions School’s Eligibility for Native American COE

Health Professions School and Degree Minimum % of Native American

Schools of Dentistry (D.D.S., D.M.D.) 0.56 Allopathic/Osteopathic Schools of Medicine (M.D., D.O.) 0.4 Schools of Pharmacy (Pharm.D.) 0.5 Behavioral or Mental Health4 0.6

3. Have been effective in recruiting Native American individuals to enroll in and graduate from the school, including providing scholarships and other financial assistance to such individuals and encouraging Native American individuals URM students from all levels of the educational pipeline to pursue health professions careers; and

4. Have made significant recruitment efforts to increase the number of Native American individuals serving in faculty or administrative positions at the school.

Further, an eligible entity for designation as Native American COE must:

1. Agree that it will give priority to Native American individuals in carrying out the program objectives described in Section I.1;

2. Establish an arrangement with one or more public or nonprofit community-based Native American-serving organizations, or public or nonprofit private institutions of higher education, including schools of nursing, whose enrollment of students has traditionally included a significant number of Native American individuals, to help carry out the program to (a) identify Native American students who are interested

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in a career in the health professions involved, and (b) facilitate the educational preparation for these students to enter the health professions school; and

3. Make efforts to recruit Native American students including students who have participated in enhancement programs at the undergraduate level or other matriculation programs established by the school to facilitate the educational preparation of the student to enter the health professions school, and assist Native American students regarding the completion of the educational requirements for a degree from the school.

If a health professions school does not meet the above listed conditions required for Native American COE, a health professions school may receive a grant to support a Native American COE program if it meets both of the following conditions:

(1) Forms a consortium in accordance with the criteria of designated HBCU COEs7 or with the criteria of eligible “Other” COEs to carry out the program objectives at the schools of the consortium; and

(2) The above consortium collectively meets the eligible Native American COE program conditions, without regard as to whether the schools individually meet such conditions.

C. “Other” COE Program:

To be eligible for designation as an “Other” COE, the health professions school involved must meet the following conditions:

1. Have an enrollment of under-represented minorities above the national average for such enrollments of health professions schools, including individuals accepted for enrollment at the school;

2. Have been effective in assisting URM students of the schools to complete the program of education and receive the degree involved.

The following table specifies the minimum graduation percentage of URM students earning a health professions degree, which is required for a health professions school or graduate program in behavioral or mental health, to qualify as an “Other” COE applicant.

Health Professions Schools Eligibility for “Other” COE

Health Professions School and Degree Minimum % of ‘Other’ URM

Schools of Dentistry (D.D.S., D.M.D.) 15.6 Allopathic/Osteopathic Schools of Medicine (M.D., D.O.) 15.9 Schools of Pharmacy (Pharm.D.) 17.0 Behavioral or Mental Health5 38.5

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3. Have been effective in recruiting URM individuals to enroll in and graduate from the school, including providing scholarships and other financial assistance to such individuals and encouraging URM students from all levels of the educational pipeline to pursue health professions careers; and

4. Have made significant recruitment efforts to increase the number of URM individuals serving in faculty or administrative positions at the school.

D. Calculation of Graduation Threshold

Each school’s graduation rate percentage will be compared to the minimum graduation percentage of Hispanic, Native American or “Other” students earning a health professions degree, which is required for a health professions school or graduate program in behavioral or mental health. If a school meets or exceeds the threshold, it will meet the graduation eligibility criterion for the COE program. To calculate their URM graduation percentage, health professions schools should:

A. Sum the appropriate URM (Hispanic, Native American, or “Other”) population that completed and successfully graduated from the health professions school with degrees across the last three years.

B. Sum the total student population that completed and successfully graduated from the health professions school with degrees across the most recent three years.

C. Divide A by B to arrive at the average designated URM percentage of successful graduates from the health professions schools with degrees across the past three years.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

• Exceeds the ceiling amount

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

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Maintenance of Effort The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by 42 U.S.C. §293(h)(3) (section 751 (h)(3) of the Public Health Service Act). Such Federal funds are intended to supplement, not supplant, existing non-Federal expenditures for such activities. Specifically, with respect to activities for which a grant made under this part are authorized to be expended, the center must agree to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the center for the fiscal year preceding the fiscal year for which the school receives such a grant.

With respect to any Federal amounts received by a center of excellence and available for carrying out activities for which a grant under this part is authorized to be expended, the center shall, before expending the grant, expend the Federal amounts obtained from sources other than the grant, unless given prior approval from the Secretary. Complete the Maintenance of Effort information and submit as Attachment 9.

Multiple Applications NOTE: Multiple applications from an organization are allowable for different designations of COE programs (e.g., Hispanic and Native Americans, or Hispanic and other).

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

Beneficiary eligibility requirements A student/trainee receiving support from grant funds must be a citizen, national, or permanent resident of the United States.

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 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-042 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

Application Page Limitation The total size of all uploaded files included in the page limit shall be no more than the equivalent of 60 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project Abstract Summary.”

Standard OMB-approved forms that are included in the workspace application package, including the Standardized Work Plan (SWP), do not count in the page limit.

Biographical sketches do count in the page limitation. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22- 042, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 60 pages will not be read, evaluated, or considered for funding.

https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

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. § 3321).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 10-14: Other Relevant Documents.

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

Program-Specific Instructions

Program Requirements In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

1. Develop a large competitive URM applicant pool through strategic partnerships and collaboration with institutions of higher education, local school districts, and other community-based entities to establish an education pipeline for health professions careers;

2. Establish, strengthen or expand structured programs to enhance URM student academic performance;

3. Develop structured programs to improve the capacity of the school for recruitment, training and retention of URM faculty, including the payment of stipends and fellowships;

4. Establish or expand effective partnerships that engage key stakeholders (e.g., federal, state, local, and national organizations) that are important to implementing, advancing, and sustaining the work of the COE Program.

Partners will help to ensure the relevancy, coordination, and timeliness of the education and training provided;

5. Advance the integration of behavioral health training into primary care settings to improve access to quality behavioral health services;

6. Develop specific activities to address Behavioral Health Integration which will target and increase the number of URM behavioral health professionals trained to address clinician burnout and improve provider resiliency;

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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7. Enhance didactic and experiential training…