BHW HRSA-22-044 (D57) PCTE-PAR_Final_clean.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Primary Care Training and Enhancement - Physician Assistant Rural Training

(PCTE-PAR) Program

Funding Opportunity Number: HRSA-22-044 Funding Opportunity Type(s): New

Assistance Listings (AL/CFDA) Number: 93.884

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: December 9, 2021

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, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: September 9, 2021

LCDR Sherray Holland, PA-C Project Officer, Bureau of Health Workforce Division of Medicine and Dentistry Telephone: (301) 443-0952 Email: sholland@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Title VII, Section 747(a)(1)(F) of the Public Health Service (PHS) Act (42 U.S.C. § 293k(a)(1)(F)) mailto:sholland@hrsa.gov mailto:sholland@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Primary Care Training and Enhancement - Physician Assistant Rural Training (PCTE-PAR) Program. The purpose of this program is to develop and implement longitudinal clinical rotations in primary care in rural areas. The program also supports the training and development of preceptors in rural areas. The PCTE-PAR Program is a component of the Primary Care Training and Enhancement (PCTE) Program, which functions to strengthen the primary care workforce by supporting enhanced training for future and current primary care clinicians and educators and to promote primary care practice.

Funding Opportunity Title: Primary Care Training and Enhancement

- Physician Assistant Rural Training (PCTE-PAR) Program

Funding Opportunity Number: HRSA-22-044 Due Date for Applications: December 9, 2021

Anticipated Total Annual Available FY 2022 Funding:

$2,100,000

Estimated Number and Type of Award(s): Approximately 7 grants

Estimated Annual Award Amount: Up to $300,000 per award Cost Sharing/Match Required: No Period of Performance: July 1, 2022 through June 30, 2027

(5 years) Eligible Applicants: Eligible entities are academically-affiliated physician assistant training programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

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

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.

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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

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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

VI. AWARD ADMINISTRATION INFORMATION

3. AWARD NOTICES

4. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

5. 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 Primary Care Training and Enhancement - Physician Assistant Rural Training (PCTE-PAR) Program.

Program Purpose

The purpose of this program is to develop and implement longitudinal clinical rotations for physician assistant students in primary care in rural areas. The program will also support the training and development of preceptors in rural areas. This experience will provide Physician Assistant (PA) students the opportunity for longitudinal primary care clinical training experiences for a minimum of 8 weeks in rural areas. The program aims to meet the health workforce goal of increasing the distribution of primary care practitioners who are ready to practice in and lead the transformation of health care systems aimed at improving access, quality of care, and cost effectiveness in rural areas.

Program Goal

The goal of the PCTE-PAR Program is to increase the number of primary care PAs who choose to practice in rural areas after graduation.

Program Objectives

1. Provide PA students with longitudinal clinical training experiences for a minimum of 8 weeks in primary care in rural areas.

2. Educate and train primary care PAs to identify and address health inequities, health disparities, and social determinants of health in the communities they serve.

3. Develop and strengthen partnerships between academia, primary care delivery sites and systems, State Offices of Rural Health, the National Rural Health Association and community based organizations to implement interprofessional rural clinical training experiences for primary care PA students.

4. Increase the number of preceptors to train PA students in rural primary care settings.

For more details, see Program Requirements and Expectations.

HHS and HRSA Priorities

You are encouraged to select and address one of HHS’s and HRSA’s clinical priorities below.

• Ending the crisis of opioid addiction and overdose in America

• Improving mental health access and care https://www.ruralhealthinfo.org/organizations/state-office-of-rural-health https://www.ruralhealthweb.org/

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• Transforming the health care system through value-based care delivery and quality improvement initiatives

• Transforming the workforce –by targeting the need

• Strengthening health care access through telehealth

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.

2. Background

This program is authorized by 42 U.S.C. § 293k(a)(1)(F) Section 747(a)(1)(F) of the Public Health Service (PHS) Act. The HRSA PCTE-PAR program aims to increase the number of PAs practicing primary care in rural settings upon graduation.

Additional information on the Bureau of Health Workforce programs can be found at https://bhw.hrsa.gov/.

Many rural communities lack access to quality health care and opioid treatment disorder programs which affect their population’s overall physical and mental health. The need for core health services (e.g., primary care, medical and hospital services, long‐term care, oral health care, and public health services) in rural areas is enormous.1 According to CDC, more than 46 million Americans, or 15 percent of the United States live in rural areas.

Moreover, rural Americans are at a greater risk of death from heart disease, cancer, unintentional injuries (such as opioid overdoses and motor vehicle accidents), chronic lower respiratory disease and stroke than the urban population. In addition, the growing opioid epidemic has plagued the United States for decades, especially in rural communities.

According to the National Vital Statistics System Mortality data, the rate of drug overdose deaths (involving drugs such as oxycodone, hydrocodone, codeine, fentanyl, and methamphetamine) increased from 4.0 to 19.6 for every 100,000 people in rural counties from 1999-2019.2 These overdose deaths have increased by 27 percent during the COVID- 19 pandemic.3

1 Daniels, Z.M., VanLeit, B.J., Skipper, B.J., Sanders, M.L. and Rhyne, R.L. (2007), Factors in Recruiting and Retaining Health Professionals for Rural Practice. The Journal of Rural Health, 23: 62-71.

2 Hedegaard H, Spencer MR (2021). Urban–rural differences in drug overdose death rates, 1999–2019. NCHS Data Brief, no 403. Hyattsville, MD: National Center for Health Statistics.

3 Centers for Disease Control and Prevention. Overdose Deaths Accelerating During COVID-19.

https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html. Accessed 01 SEP 2021.

https://bhw.hrsa.gov/ https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.htm

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These conditions, along with little to no health insurance, higher rates of cigarette smoking, obesity, sedentary lifestyles and inadequate nutrition, all lead to poor health outcomes in the rural communities.4 The current primary care workforce is not adequate to meet the health needs of the nation, particularly in rural or underserved areas.

PAs are needed to respond to the current primary care physician shortage and to help mitigate maldistribution of primary care providers. It is estimated that by 2033 there will be a shortage of physicians between 21,400 and 55,200.5 Currently, 25 percent of PAs practice in primary care, a decrease in the last five years (28.3 percent were reported in 2015).

Moreover, the number of rural PAs has also decreased over the last three decades.6 Fortunately, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), Inc. expects that the number of PA educational programs will grow from 250 today to 304 by 2023, thus increasing the certified PA workforce.7 This is consistent with the National Center for Health Workforce Analysis Report stating the national demand for primary care PAs is projected to grow by 5,670 Full-Time-Equivalent (FTEs) - from 33,390 FTEs in 2013 to 39,060 FTEs in 2025- a 17 percent increase.8

PA students early in their educational process will discover many facets of medicine as their training progresses. According to a survey by Larson, et. al., PA programs reported that rural training is “very important” to their program goals, yet only half of these programs required any rural clinical training.9 These programs must encourage and support student interest in primary care and rural areas.10,11 Last year, the Physician Assistant Education Association (PAEA) developed a medication-assisted treatment (MAT) Training Initiative to providing resources to focus on assisting PA programs incorporating MAT waiver training into their curricula.12 In addition to PAEA’s initiative, The Department of Health and Human Services new buprenorphine practice guidelines in April 2021 exempted PAs from the federal training requirements for providers treating up to 30 patients with opioid use disorder (OUD).13 This will ensure PAs have more access to treat OUD patients. Providing specialized curriculum and clinical rotations geared towards rural health will give students the knowledge and experience to work with this vulnerable population.

4 Centers for Disease Control and Prevention. About Rural Health. https://www.cdc.gov/ruralhealth/about.html. Accessed 28 April 2021.

5 The Complexities of Physician Supply and Demand: Projections From 2018 to 2033. https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf. Accessed 20 APR 2021.

6 Larson E, Coulthard C, Andrilla C. What makes physician assistant (PA) training programs successful at training rural PAs? WWHAMI Rural Health Research Center Policy Brief #164, 2018.

7 National Commission on Certification of Physician Assistants, Inc. (2020, April). 2019 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants. Retrieved Date, from http://www.nccpa.net/research 8 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. Rockville, Maryland.

9 Larson E, Coulthard C, Andrilla C. What makes physician assistant (PA) training programs successful at training rural PAs? WWHAMI Rural Health Research Center Policy Brief #164, 2018.

10 Larson, F. (2019). Characteristics of Physician Assistant Students Planning to Work in Primary Care: A National Study. The Journal of Physician Assistant Education, 30(4), 200–206.

11 Feldman, M. (2018). Early Exposure to Underserved Patients and Its Impact on Initial Employment Decisions Regarding Physician Assistants.

The Journal of Physician Assistant Education, 29(3), 144–149.

12 Physician Assistant Education Association (2020). Medication Assisted Treatment Waiver Training Initiative.

https://paeaonline.org/resources/public-resources/mat-waiver-training-initiative. Accessed 01 SEP 2021.

13 American Academy of Physician Assistants (2021). New Guidelines for Buprenorphine Treatment Provide Exemption to Burdensome Training Requirements. https://www.aapa.org/news-central/2021/04/new-guidelines-for-buprenorphine-treatment-provide-exemption-to-burdensome-training-requirements/ https://www.cdc.gov/ruralhealth/about.html https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf http://www.nccpa.net/research https://paeaonline.org/resources/public-resources/mat-waiver-training-initiative

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Rural communities have difficulty creating, recruiting, and sustaining an adequate health care workforce.14 Studies have shown that students who had a rural background, completed a rural training rotation and expressed interest to work and practice in a smaller community or their hometown are more likely to practice in a rural primary care setting upon graduation.15,16 Incentives that are effective for rural recruitment are stipends and scholarships for students who are committed to practice in rural areas after graduation.

Effective clinical site and preceptor recruitment and retention are essential to the core functioning of every PA program and the long-term health of the PA profession.17 Therefore it is important to provide funding to preceptors who train these students in their clinic/hospital to pay for the period of supervised clinical training.18 Ultimately, successful recruitment and retention efforts must include obtaining students interested in rural health during the admission process, developing specific didactic training, coordinating clinical rotations in rural primary care and providing economic incentives for students and preceptors.

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Glossary. In addition, the following definitions apply to the PCTE-PAR Program for Fiscal Year 2022:

Health Equity is [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.19

Longitudinal clinical rotation means a long term clinical rotation (at least 8 weeks) with a clinical partner, focusing on the care of rural or tribal communities.

National Provider Identifier (NPI) is the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The NPI is a unique identification number for covered health care providers. Additional information about NPIs can be found at the following site: https://nppes.cms.hhs.gov/#/.

14 Daniels, Z.M., VanLeit, B.J., Skipper, B.J., Sanders, M.L. and Rhyne, R.L. (2007), Factors in Recruiting and Retaining Health Professionals for Rural Practice. The Journal of Rural Health, 23: 62-71.

15 Larson, F. (2019). Characteristics of Physician Assistant Students Planning to Work in Primary Care: A National Study. The Journal of Physician Assistant Education, 30(4), 200–206.

16 Daniels, Z.M., VanLeit, B.J., Skipper, B.J., Sanders, M.L. and Rhyne, R.L. (2007), Factors in Recruiting and Retaining Health Professionals for Rural Practice. The Journal of Rural Health, 23: 62-71.

17 Physician Assistant Education Association: Issue Brief. 2020. Payment of Clinical Sites and Preceptors in PA Education.

https://paeaonline.org/wp-content/uploads/2020/10/PaymentClinicalSites-PreceptorsPAEducation.pdf. Accessed 20 APR 2021.

18 Physician Assistant Education Association: Issue Brief. 2020. Payment of Clinical Sites and Preceptors in PA Education.

https://paeaonline.org/wp-content/uploads/2020/10/PaymentClinicalSites-PreceptorsPAEducation.pdf. Accessed 20 APR 2021.

19 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.

https://nppes.cms.hhs.gov/#/ https://paeaonline.org/wp-content/uploads/2020/10/PaymentClinicalSites-PreceptorsPAEducation.pdf https://paeaonline.org/wp-content/uploads/2020/10/PaymentClinicalSites-PreceptorsPAEducation.pdf https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf

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Primary care, for the purpose of this NOFO, includes family medicine, general internal medicine internal, general pediatrics, and combined general internal medicine with general pediatrics.

Rural clinical site is defined as a clinical rotation site located in an area considered rural by the Federal Office of Rural Health Policy (FORHP), using the Rural Health Grants Eligibility Analyzer https://data.hrsa.gov/tools/rural-health. (See the Health Workforce Glossary for the full definition for “Rural”).

Stipend is defined as subsistence allowance for students (trainees) to help defray living expenses during the time of their rural primary care rotation training experience, and are not provided as a condition of employment. The stipend does not include tuition, fees, health insurance, or other Participant/Trainee Support costs associated with the training program.

Telehealth is defined as the use of electronic information and telecommunications technologies to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health. Telehealth can be an important tool for delivering services and resources to HRSA’s target populations. HRSA strongly encourages Bureaus and Offices to include telehealth as a mechanism to meet programmatic goals in the NOFO, as relevant. Additional resources to assist Bureaus and Offices, and applicants, in determining how to include telehealth in HRSA-funded programs may be found at https://telehealth.hhs.gov/.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New.

HRSA will provide funding in the form of a grant.

https://data.hrsa.gov/tools/rural-health https://bhw.hrsa.gov/grants/resourcecenter/glossary https://telehealth.hhs.gov/

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2. Summary of Funding

HRSA estimates approximately $2,100,000 to be available annually to fund approximately seven 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 $300,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. 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 PCTE-PAR Program, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce recipient funding levels beyond the first year if they are unable to fully succeed in achieving the goals listed in application, or take other enforcement action as appropriate.

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

Eligible entities are academically-affiliated physician assistant training programs accredited by the ARC-PA.

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 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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• Fails to include all required documents, including appropriate tables, as part of the application

• Fails to satisfy the accreditation requirements

Accreditation The applicant must submit accreditation documentation for the PA program in Attachment 9 The applicant organization must provide: (1) a statement that they hold continuing accreditation from the relevant accrediting body and are not on probation, (2) the dates of initial accreditation and next expected accrediting body review, (3) the accreditation start and expiration dates, and (4) a web link to the accreditation status. The full letter of accreditation is not required. Failure to submit the required accreditation documentation may be considered by HRSA as non-responsive and ineligible for consideration. Applicants are required to maintain their accreditation or state approval status throughout the period of performance and notify HRSA of change in status.

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. § 295n-2(b) (PHS Act section 797(b)). Such federal funds are intended to supplement, not supplant, existing non-federal expenditures for such activities. Complete the Maintenance of Effort information and submit as Attachment 6. HRSA will enforce statutory MOE requirements through all available mechanisms.

Multiple Applications Multiple applications from an organization are not allowable. An “organization” for this NOFO is defined by having a valid Data Universal Numbering System (DUNS) number or Unique Entity Identifier (UEI).

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.

Beneficiary Eligibility A student, faculty member, or preceptor receiving support from grant funds must be a citizen, national, or permanent resident of the United States.

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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.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-044 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 not exceed the equivalent of 75 pages when printed by HRSA. The page limit includes the 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 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- 044, 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html 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

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application does not exceed the specified page limit. Any application exceeding the page limit of 75 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-044 before 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 shall be included in Attachment 10: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction.

Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

Program-Specific Instructions

Program Requirements

Programs must:

1. Provide students with a minimum of 8 weeks of longitudinal clinical rotations in primary care at a rural clinical site. The clinical site must be located in an area considered rural as determined by the Federal Office of Rural Health Policy (FORHP), using the Rural Health Grants Eligibility Analyzer.

https://data.hrsa.gov/tools/rural-health.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx https://data.hrsa.gov/tools/rural-health

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2. Develop and provide curriculum content and clinical and didactic experiences on health inequities, health disparities, social determinants of health, and the unique characteristics and challenges in primary care in rural communities.

3. Provide a stipend to students while they are in clinical rotation(s) at a rural site.

Students must be matriculated and currently in your program to receive this stipend.

4. Ensure PA students apply for a NPI number and collect the NPI numbers from students who participate in the program.

5. Provide clinical and didactic training experiences for PA students, faculty and preceptors in the use of telehealth/telemedicine technologies, factors affecting rural health, and cultural competencies to improve access to health services and improved quality of care.

6. Provide continuing education and training for development of PA preceptors in rural areas.

7. Incorporate interprofessional learning experiences for physician assistants, both in the didactic content and in clinical rotation, including collaboration with physicians, advanced practice providers (e.g. nurse practitioners and PAs), allied health professionals, nurses, and other health care workers.

8. Develop a tracking system that collects data on the performance metrics of the program, to include, but not limited to, the following measures:

• Number and types of partnerships developed to strengthen clinical training in rural areas.

• Number of clinical training site that offer interprofessional training.

• Number of interprofessional trainees by profession and discipline.

• Number of preceptors trained.

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:

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment or it will count toward the page limitation. For information required in the Project Abstract Summary Form, see below and Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole, stating how the program will incorporate the minimum of 8 weeks of rural primary care rotations into the existing PA training program.

2. The total number of PA trainees per class.

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

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3. The number of PA trainees to complete the longitudinal clinical rural rotation(s) per year.

4. Specific, measurable objectives that the project will accomplish.

5. Which of the clinical priorities will be addressed by the project, if applicable.

6. How the proposed project for which funding is requested will be accomplished, i.e., the "who, what, when, where, why and how" of a project.

7. If applicable, provide a statement requesting priority and/or preference.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Any attachments referenced in a narrative section may be considered during the objective review.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well-organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

Narrative Section Review Criteria Review Criterion Points

Purpose and Need (1) Purpose and Need 15

Response to Program Purpose:

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(a) 15

(b) 15

(c) 5

Impact:

(a) Evaluation and Technical

Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical

Support Capacity

(b) Project Sustainability

(a) 10

(b) 10

Organizational Information, Resources, and Capabilities

(4) Organizational Information, Resources and Capabilities

Budget and Budget Justification Narrative

(5) Support Requested 10

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PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the areas that PA students would ultimately serve.

Describe the purpose and need for the proposed project, including the following:

1. Describe data on the shortages of primary care providers in rural areas, demographics, social determinants of health, health disparities, and health care needs of the population and communities the PA students will serve.

2. Describe the need for providers, preceptors, and faculty with the skills to address training and education of PAs in primary care in rural areas and any training gaps.

3. Describe in particular how you will increase the number of primary care PAs, as members of interdisciplinary teams, providing community based services in rural areas.

4. Identify rural clinical training site(s) where the PA students will train and include information depicted in the Table 1 example as Attachment 5.

5. Describe the needs of the rural clinical training sites you will enhance through this project and benefit to the community.

6. Describe how your proposed project is expected to improve health care for the rural populations described.

7. Identify gaps in telehealth capacity in the clinical training sites and its use in educational programs where the students will train.

8. Discuss existing academic and community programs and community linkages including academia, primary care delivery sites and systems, State Offices of Rural Health, the National Rural Health Association and other community-based organizations for the development of rural clinical training sites for primary care PA students.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections —

(a) Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (a).

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. Your work plan must be submitted through the Standardized Work Plan (SWP) Form located in the Grants.gov workspace. The SWP form is organized by budget period and must include all activities and deliverables for each

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objective and program goal. The program goals for this NOFO must be entered in the Program Goals section of the SWP form. For example, Goal 1 in the Purpose section of the NOFO will need to be entered as Goal 1 in the SWP form. Objectives and sub-objectives can be tailored to your project needs. Objectives may be tagged with organizational priorities by selecting applicable priorities on the SWP form. For the purpose of this NOFO, please write in COVID-19 or Health Equity in the “Other Priority Linkage” if your objective or sub-objectives align with those priorities. Form instructions are provided along with the SWP form, and are included in the application package found on Grants.gov.

You must complete the Standardized Work Plan (SWP) mandatory form in the Application Package.

1. Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section.

2. Describe the timeframes, deliverables, and primary care and other key partners required during the grant period of performance to address each of the needs described in the Purpose and Need section.

3. Describe the cultural, racial, linguistic, and geographic diversity of the rural populations served.

4. Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation.

5. Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further, the extent to which these contributors address the cultural, racial, linguistic and/or geographic diversity of the populations and communities served.

6. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented.

(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion #2 (b).

Describe how you will prepare PA students to practice primary care in rural areas. Also describe your objectives, proposed activities, and strategies, and provide evidence for

(1) how your program provides health care services, including telehealth, in settings that provide interdisciplinary, team-based care in rural areas, (2) align with and drive the work plan, (3) incorporate each of the program goals and objectives and expectations of the NOFO; and (4) address the needs in the Purpose and Need section.

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1. Describe how you will implement a minimum of 8 weeks longitudinal rotation in rural primary care as defined in this NOFO.

2. Describe your goals, objectives, and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Objectives must be specific, measurable, achievable, relevant and timely.

3. Describe how you plan to develop effective tools and strategies for rural faculty and preceptor training and development, outreach, collaborations, and clear lines of communication.

4. Describe how you plan to engage the community and clinical training sites in making decisions on the program and how you plan to identify the community’s priority needs and solutions for increasing the number of PAs who chose to practice in rural areas following graduation.

5. Describe a plan to disseminate reports, products, and/or project outputs so project information is provided to key audiences.

6. Provide a rural clinical training site table with the projected number of students to be trained in primary care in rural areas for each year of the project.

7. Provide a one page logic model appropriate for designing and managing the project that includes objectives, activities, and short, intermediate and long term outcomes as Attachment 1

8. Document the procedure for ensuring the data collection, management, storage, and reporting of NPI numbers of participants in the program.

9. Describe your process to track trainees after graduation for up to one year.

10. Describe the strength of the goals, objectives, and activities to enhance training in rural area and the extent to which the project is likely to have the greatest impact on rural health outcomes in the rural clinical learning sites and in the choice of graduates to practice in rural areas.

11. Describe a tracking system to collect data on the performance metrics of the program to include, but not limited to, the following measures:

• Demographic information of students including race, gender, age and ethnicity.

• Number of program participants and completers.

• Number of clinical hours for each student in rural, primary care settings and

Medically Underserved Communities (MUCs) completed during longitudinal clinical rotations.

• Number of graduates who practice in primary care, rural, and MUCs.

• Number of courses and trainings on cultural competency/health disparities, health equity/social determinants of health, and telemedicine/telehealth.

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• Number of students who received training in the unique characteristics and challenges in rural communities.

• Number and types of partnerships developed to strengthen clinical training in rural areas.

• Number of clinical training site that offer interprofessional training.

Logic Model

Submit a logic model (Attachment 1) for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes.

While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

• Goals of the project (e.g., objectives, reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. You can find additional information on developing logic models at the following website:

https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2

(c).

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges. Include attention to the following as applicable:

1. Describe the challenges related to the achievement of project objectives, the work plan according to the proposed timetable, and the logic model and the approaches that you will use to resolve such challenges.

https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf

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2. Describe challenges in recruiting PA students and preceptors in the longitudinal clinical rotation(s) and the approaches that you will use to resolve such challenges.

3. Identify challenges in locating rural clinical training sites for the longitudinal clinical rotation(s) in primary care and the approaches that you will use to resolve such challenges.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a).

Describe your plan for program performance evaluation. A comprehensive evaluation will yield outcome data that both you and HRSA can use throughout the project to ensure the success of the project.

1. Describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation personnel and organizational support, collaborative partners, budget, and other resources); key processes; variables to be measured; expected outcomes of the funded activities;

and a description of how all key evaluative measures will be reported. In the Attachments section (IV. 2. vi., Attachment 2), attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form.

2. Demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

3. Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. At the following link, you will find the required data forms for this program:

http://bhw.hrsa.gov/grants/reporting/index.html.

4. Describe the data collection strategy to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes.

5. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also http://bhw.hrsa.gov/grants/reporting/index.html

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should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

6. Describe your process to track trainees after program completion/graduation for up to 1 year, to include collection of trainees’ NPI.

7. Document the procedure for assuring the data collection, management, storage, and reporting of NPI numbers for individuals participating in the Program. (Note:

Trainees who receive HRSA funds as a result of this award must apply for an NPI for the purpose of collecting post-graduation employment demographics).

8. Include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections.

Additional information on RCQI is available at the following website:

https://www.healthworkforceta.org//wp-content/uploads/2016/06/RCQI_Resource_Guide.pdfhttps://www.healthworkforce ta.org//wp-content/uploads/2016/06/RCQI_Resource_Guide.pdf

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3

(b).

Provide a clear plan for project sustainability after the period of federal funding ends.

Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population.