BHW HRSA-22-053 (U77) AHEC_Final.pdf

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Health Careers and Financial Support

Area Health Education Centers Program

Funding Opportunity Number: HRSA-22-053

Funding Opportunity Type(s): New, Competing Continuation

Assistance Listings (AL/CFDA) Number: 93.107

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: April 6, 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: January 6, 2022

Christina Lottie Public Health Analyst, Bureau of Health Workforce Telephone: (301) 287-2602 Email: AHECProgram@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C.294a (Section 751 of the Public Health Service Act) mailto:AHECProgram@hrsa.gov

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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 listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Area Health Education Center (AHEC) Program. The purpose of the AHEC Program is to develop and enhance education and training networks within communities, academic institutions, and community-based organizations. In turn, these networks seek to increase diversity among health professionals, broaden the distribution of the health workforce, enhance health care quality, and improve health care delivery to rural and underserved areas and populations.

Awards are subject to the availability of appropriated funds.

Funding Opportunity Title: Area Health Education Centers

Funding Opportunity Number: HRSA-22-053

Due Date for Applications: April 6, 2022

Anticipated Total Annual Available

FY 2022 Funding:

$43,250,000

Estimated Number and Type of Award(s): Up to 55 cooperative agreement(s)

Estimated Annual Award Amount:

The AHEC Program exists in two phases:

AHEC Infrastructure Development (ID) and AHEC Point of Service Maintenance and Enhancement (POSME). Estimated annual award amount varies and total award amount will be based upon the number of centers a recipient has. For FY 2022, anticipated amount is $148,000 per center in the POSME phase and $250,000 per center in the ID phase.

Cost Sharing/Match Required: Yes

Period of Performance: September 1, 2022 through

August 31, 2027 (5 years)

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Eligible Applicants: Public or non-profit private accredited schools of allopathic or osteopathic medicine, an incorporated consortia made up of such schools, or the parent institution(s) of such schools. In states with no existing AHEC Program, schools of nursing may apply for an award in the infrastructure development phase.

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 for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website 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

vii. 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. Program Purpose

This notice announces the opportunity to apply for funding under the Area Health Education Centers (AHEC) Program.

The purpose of the AHEC Program is to develop and enhance education and training networks within communities, academic institutions, and community-based organizations. In turn, these networks seek to increase diversity among health professionals, broaden the distribution of the health workforce, enhance health care quality, and improve health care delivery to rural and underserved areas and populations.

Program Goals

The Bureau of Health Workforce (BHW) seeks to improve the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. The AHEC Program supports the following three (3) overarching goals:

1. Diversity: Preparing a diverse, culturally competent primary care workforce that can address the needs of the communities we serve;

2. Distribution: Improving workforce distribution throughout the nation, particularly among rural and underserved areas and populations; and

3. Practice Transformation: Developing and maintaining a health care workforce that is prepared to deliver high quality care in a transforming health care delivery system with an emphasis on rural and underserved areas and communities.

These three overarching goals complement the primary objectives of the AHEC Program as required by Section 751 of the Public Health Service Act (PHS Act) and are discussed further below in the Program Objectives section.

Program Structure

This NOFO solicits applications for a five-year project period. Successful applicants will be awarded cooperative agreements to establish and/or advance statewide AHEC programs.

This award is made to the AHEC program office which then works with AHEC centers to implement the activities.

The AHEC Program exists in two phases: AHEC Infrastructure Development (ID) and AHEC Point of Service Maintenance and Enhancement (POSME). These two phases collectively embrace the goal of increasing the number of students in the health professions who will pursue careers in primary care and are prepared to practice in rural and underserved areas and populations. Total award amounts depend upon the number

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of centers approved for the AHEC ID and POSME phases.

All AHEC Programs start in the ID phase, where the planning must reflect the projected growth of the project to include the resulting number of anticipated centers at the conclusion of the expansion period. The amount of time in the ID phase is limited to six

(6) years for a center and a total of twelve (12) years for the AHEC Program (for complete statutory information regarding the establishment of an AHEC, (see section VI Award Administration Information). Upon transition to the POSME phase, the focus shifts to maintaining and improving the effectiveness of the established AHEC program(s) based on community needs. HRSA expects that throughout the ID and POSME phases the programmatic approaches and activities detailed in this NOFO will be accomplished and outcomes will be documented.

Applicants must clearly identify their request for participation in the ID or POSME phase in the abstract (see section IV Application and Submission Information for additional eligibility information).

1. AHEC ID phase for initiating, planning, developing, operating and evaluating an AHEC program:

• Up to two years of the five-year project period can be used for a planning period.

2. AHEC POSME phase for improving the capacity and effectiveness of the program through ongoing evaluation:

• Up to one year of the five-year project period can be used for a planning period.

AHEC Program award recipients contract with centers to coordinate and facilitate workforce education and training projects, especially the specialized training of health professions students and health care providers as detailed under the heading of Program Requirements and Expectations in Section IV.

Program Objectives

The AHEC Program contributes toward the HRSA mission to increase access to care for underserved individuals and communities through their academic and community partnerships that create training opportunities for health professions students and health care professionals. The AHEC Programs must carry out the following activities:

• Develop and implement strategies to recruit individuals from underrepresented minority populations and from disadvantaged and rural backgrounds into health professions, and support such individuals in attaining such careers;

• Develop and implement strategies to foster and provide community-based training and education to individuals seeking careers in health professions within underserved areas for the purpose of developing and maintaining a

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diverse health care workforce that is prepared to deliver high-quality primary care in underserved areas or for health disparity populations1, in collaboration with other Federal, State, and local health care workforce development agencies and programs in health care safety net sites;

• Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers (CHW), public and allied health professionals, or other health professionals, as practicable;

• Facilitate continuing education and information dissemination for health care professionals, with an emphasis on providing care in underserved areas and for health disparity populations;

• Propose and implement effective program and outcomes measurement and evaluation strategies; and

• Establish a youth public health program to expose and recruit high school students into health careers, with a focus on careers in public health.

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.

• Enhancing health equity and reducing health disparities

• Diversifying the health workforce

• Ending the crisis of opioid addiction and overdose in America

• Improving behavioral/mental health access and care

• 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

• Preventing and reducing maternal mortality

• Responding to the COVID-19 pandemic

1 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 and Underserved rural populations See National Institute on Minority Health and Health Disparities, Health Disparity Populations (April 1, 2021).

https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1430059690-1810622172&term_occur=999&term_src=title:42:chapter:6A:subchapter:V:part:D:section:294a https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1355265636-252276045&term_occur=999&term_src=title:42:chapter:6A:subchapter:V:part:D:section:294a https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1355265636-252276045&term_occur=999&term_src= https://www.nimhd.nih.gov/about/overview/ https://www.nimhd.nih.gov/about/overview/

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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 recipients are able to continue programmatic activities, can coordinate effectively, and can implement recovery plans when emergencies disrupt project activities. You 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 AHEC Scholars training.

2. Background

The AHEC Program is authorized by Section 751 of the PHS Act (42 U.S.C. § 294a).

The AHEC Program has a long-standing history of supporting activities focused on health careers exposure, with a particular emphasis on innovative, evidence-based strategies to strengthen science, technology, engineering, and math (STEM) skills.

AHEC Programs develop and enhance education and training networks within communities, academic institutions, and community-based organizations. In turn, these networks develop the health care workforce, broaden the distribution of the health workforce, enhance health care quality, and improve health care delivery to rural and underserved areas and populations. In 2017, the AHEC Program shifted away from activities primarily focused on middle/high school health careers exposure programs to targeting students further along their academic pathway, with special emphasis on the creation of the AHEC Scholars Program.

The 2019 U.S. Census Bureau indicated that approximately 40% of the U.S. population is made up of racial and ethnic minorities.2 With national population projections estimating that ethnic minorities will account for almost half of the U.S. population by 2060,3 diversifying the health care workforce is linked to increased cultural competence, quality of care, and better health outcomes. 4,5,6

2 United States Census Bureau, Quickfacts Statistics 2019. https://www.census.gov/quickfacts/US 3 Vespa, J., Medina, L., Armstrong, D. (2020). Demographic Turning Points for the United States:

Population Projections for 2020 to 2060, 25-1144.

https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf 4 Kenya, S., Young, B., Vega, N., Bringuez-Sanchez, J., Reynolds, A., & Symes, S. (2019). Tips for Building a Pathway to Medicine for Underrepresented Minority Students. Journal of Best Practices in Health Professions Diversity, 12(2), 181–191.

5 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 6 Salsberg, E., Richwine, C., Westergaard, S., Portela Martinez, M., Oyeyemi, T., Vichare, A., & Chen, C.

P. (2021). Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce. JAMA Network Open, 4(3), e213789.

https://doi.org/10.1001/jamanetworkopen.2021.3789 https://www.census.gov/quickfacts/US https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf https://doi.org/10.1016/j.hpe.2020.01.002 https://doi.org/10.1001/jamanetworkopen.2021.3789

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The crisis of the coronavirus disease 2019 (COVID-19) has prompted concern about deficiencies and disparities in the health care system in the United States.7 Ensuring a diverse public health and health care workforce to provide services to diverse populations, in combination with other strategies, can increase access to and quality of health care for vulnerable populations and decrease health care disparities. 7

The Journal of Healthcare, Science and the Humanities report, “Increasing Diversity in the Health Professions: Reflections on Student Pipeline Programs” highlighted the significant role in addressing strategies for development of collaboration and evidence-based recruitment and retention. The report states, “There are many challenges facing the health professions workforce. A diverse public health and healthcare workforce is necessary for improving the health status of Americans and in decreasing and eliminating disparities. Student programs that enhance recruitment of underrepresented populations, in combination with other strategies, can increase access to and quality of healthcare for vulnerable populations and decrease healthcare disparities.”8

Program Definitions

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

Area Health Education Center Program Office: a cooperative agreement program consisting of an entity that has received an award from HRSA under PHS Act section 751(a)(1) or section 751(a)(2). The AHEC Program Office contracts with the centers and provides 75% of the funding to complete the work.

7 Daley, G., Barabino, G., Ajijola, O., Bright, C., Rice, M.V., Laurencin, C. (2021). COVID Highlights Another Crisis: Lack of Black Physicians and Scientists, 2(1), 2-3.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311898/ 7 Karen E. Bouye, PhD, MPH, MS, Karl J. McCleary, PhD, MPH, and Kevin B. Williams, PhD, MPH (2016). Increasing Diversity in the Health Professions: Reflections on Student Pipeline Programs, 6(1):

67–79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890504/ 8 Bouye, K., McCleary, K., Williams, K. (2016) Increasing Diversity in the Health Professions: Reflections on Student Pipeline Programs. J Sci Humanit, 6(1): 67-79 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890504/ https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311898/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890504/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890504/

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Area Health Education Center: a public or nonprofit private organization that has a cooperative agreement or contract in effect with an entity that has received an award from HRSA under PHS Act section 751(a)(1) or section 751(a)(2). Such organizations may include hospitals, health organizations with accredited primary care training programs, accredited physician assistant educational programs associated with a college or university, and universities or colleges not operating a school of medicine or osteopathic medicine.9 Under contract with the AHEC Program Office, the centers receive 75% of the funding to complete their work.

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. The disparity impact statement will provide the framework for ongoing monitoring and determining the impact of the community-based education and training program. Below are available HHS resources:

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

SAMHSA.gov: Disparity Impact Statement

Promoting equity is essential to the HHS mission of protecting the health of Americans and providing essential human services. This view is reflected in Executive Order (E.O.)

13985 entitled Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (Jan. 20, 2021).

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.”10

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.

9 “The Secretary shall ensure that each area health education center program includes at least 1 area health education center, and that each such center— (A) is a public or private organization whose structure, governance, and operation is independent from the awardee and the parent institution of the awardee; (B) is not a school of medicine or osteopathic medicine, the parent institution of such a school, or a branch campus or other subunit of a school of medicine or osteopathic medicine or its parent institution, or a consortium of such entities.”

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

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Individuals at the nexus of multiple identities often experience unique forms of discrimination or systemic disadvantages, including in their access to needed services.11

Health Disparity Population: A population that has a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population, as compared to the health status of the general population.

It further includes populations for which there is a significant disparity in the quality, outcomes, cost, use of, access to, or satisfaction with health care services, as compared to the general population.

Underserved Communities: “[The] 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.’”12

II. Award Information

1. Type of Application and Award

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

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Participate in the planning and development of each AHEC Scholars Program;

• Review, and, if necessary, comment on each AHEC program office’s/award recipient’s work plan, evaluation plan, interdisciplinary program curriculum that includes a set of clinical, didactic, and community-based training activities in rural and/or underserved areas;

• Review and recommend changes to peer-reviewed publications and other resources developed by AHEC program offices, as specified by HRSA;

• Review and approve written materials that include performance data produced by the AHEC program office/award recipient prior to publication;

11 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.

12 Executive Order 13985, at § 2(b).

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

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• Coordinate with other Bureaus within HRSA to develop partnerships among funded programs;

• Coordinate work plan activities with other HHS federally-funded cooperative agreement recipients;

• Review and approve contracts and agreements between the AHEC Program and centers;

• Provide consultation and technical assistance, as appropriate, to each AHEC program office to assist AHEC program offices in developing strategies for disseminating AHEC work in order to target multiple audiences interested in pipeline programs and health workforce development; and

• Coordinate quarterly technical assistance calls with AHEC project directors and other program partners as appropriate.

The cooperative agreement recipient’s responsibilities will include:

• Develop and implement contractual agreements, which must include a statement of work, designation of roles and responsibilities, and appropriate financing provisions between the AHEC Program Office and the governing body of each center;

• Monitor, evaluate, and report on any sub-recipient center activities. Ensure centers comply with all HRSA grant and program requirements. Specifics include but are not limited to:

o Center Director minimum .75 Full-Time Equivalents (FTEs) allocated solely to conduct center duties and responsibilities; and o Community-based governing or advisory board responsible for the hiring and/or termination of the Center Director.

• Develop strategic partnerships (see Program Requirements and Expectations);

• Provide quarterly updates during the planning years of the project period;

• Comply with all HRSA and AHEC program reporting requirements, to include, but not be limited to:

o Annual Performance Reports (APRs) o Annual Non-Competing Continuation Applications must include:

o Work Plan Progress Report o Proposed work plan for the upcoming year o Evaluation Report

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o Federal Financial Report (FFR) o Final Report (FR) o Final Performance Report (FPR)

• Identify a Program Director with a faculty appointment to assume responsibility for the overall direction and coordination of the AHEC Program. The AHEC Program Director must serve on the admissions committee for the school of medicine (or nursing, if applicable);

• Identify an individual to function as an AHEC Program Evaluator with a minimum of a .5 FTE; and

• Respond to all information requests by the established deadline.

2. Summary of Funding

HRSA estimates approximately $43,250,000 to be available annually to fund up to 55 recipients. Current estimates of the funding level are $148,000 per center per year in the AHEC POSME phase. You may apply for a ceiling amount of up to $250,000 per year per center for the AHEC ID phase (includes both direct and indirect, facilities and administrative costs). AHEC awards are made to the AHEC Program Office who then contracts with the AHEC centers to conduct the required activities based on the phase of that center. This total cost includes both direct and indirect, facilities and administrative costs per year. The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation, and will vary as a function of the number of centers supported.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 September 1, 2022 through August 31, 2027 (5 years).

Funding beyond the first year is subject to the availability of appropriated funds for AHEC Program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

Total award amounts depend upon the number of centers approved for the AHEC ID and POSME phases (see the Purpose Section 1 for clarification on the difference between the two). If the total amount appropriated to carry out the AHEC Program is not sufficient to provide a funding amount of $250,000 per center, the Secretary may reduce the per center amount as necessary.

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 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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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.

Not less than 75 percent of the total amount provided to an AHEC Program office/award recipient shall be allocated to the AHECs (for additional details, please see Section IV.6.

Funding Restrictions).

III. Eligibility Information

1. Eligible Applicants

Entities eligible to apply are public or nonprofit private accredited schools of allopathic medicine or osteopathic medicine, an incorporated consortia made up of such schools, or the parent institution(s) of such schools. In states and territories in which no AHEC Program is in operation, an accredited school of nursing is an eligible applicant.

AHEC Requirements in Sections 751(d)(2)(A) and 751(d)(2)(B) of the PHS Act

For FY 2022, the Consolidated Appropriations Act, 2021 (Public Law 116-260) gave the Secretary authority to grant a waiver of the AHEC requirements under sections 751(d)(2)(A) and 751(d)(2)(B) of the PHS Act13 to programs meeting certain requirements, including that the program must have been operating under section 751 of the PHS Act on or before January 1, 2009. Applicants seeking a waiver must submit their request with their grant application. Decisions regarding the waiver requests are contingent upon extension of the Secretary’s waiver authority for FY 2022 and HRSA administrative review of each waiver request. For instructions, please see Attachment 9.

Foreign entities are not eligible for these awards.

2. Cost Sharing/Matching

Matching is required for this program. The recipient shall provide documentation that it will make available (directly or through contributions from state, county, or municipal government, or the private sector) recurring non-Federal contributions in cash and in kind, equal to not less than 50 percent of the operating costs of the AHEC Program.

Thus, the matching ratio for AHEC awards is one to one (1:1), federal funds to non-

13 These sections of the statute provide, “The Secretary shall ensure that each area health education center program includes at least 1 area health education center, and that each such center— (A) is a public or private organization whose structure, governance, and operation is independent from the awardee and the parent institution of the awardee; (B) is not a school of medicine or osteopathic medicine, the parent institution of such a school, or a branch campus or other subunit of a school of medicine or osteopathic medicine or its parent institution, or a consortium of such entities.”

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Federal contributions.14 If the recipient fails to provide some or all of the required matching, the Grants Management Officer will make a downward adjustment in the federal award.

Examples of match include:

1) Non-federal cash match of at least 25 percent of the total match is to be provided in cash.

2) Other contributions providing 75 percent of the total match may include:

• In-kind time and effort (provided by a third-party, non-salaried, individual).

• Unrecovered indirect costs.

• Allowable/allocable third-party donated items of value or services.

• Program Income (if expressly permitted by the Notice of Award).

The budget justification narrative located in Section IV.2.iv MUST include a line-item breakdown and narrative description of all matching funds proposed for this project.

Matching funds must be non-federal contributions related directly to carrying-out project activities. Applications that fail to address cost sharing/matching requirements will be deemed ineligible and not considered for funding under this announcement (see Attachment 9).

Waiver 75 Percent of Matching Funds – First Three Years:

An entity may apply to the Secretary for a waiver of not more than 75 percent of the matching fund amount required by the entity for each of the first three (3) years (AHEC ID Phase)the entity is funded through an award under PHS Act section 751(a)(1) . To be considered for a waiver, an applicant must present a written request for a waiver as Attachment 6. Unless a waiver of the matching funds requirement is requested and approved, funds awarded may only be expended with the understanding that the matching requirement must be met. This waiver is only applicable for new AHEC Program award recipients.

3. Cost sharing/matching is required for this program.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 address cost sharing/matching requirements

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

14 PHS Act, §751(e).

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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.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 7.

HRSA will enforce statutory MOE requirements through all available mechanisms.

NOTE: Multiple applications from an organization are not allowable. For the purposes of this NOFO, an organization means a campus or a division of a university that has its own grounds, buildings, and faculty. Therefore, one application per campus is allowed.

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.

A student/trainee receiving support from award 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.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form, and use the Project Abstract Summary Form 2.0 in workspace to complete the Project Abstract Summary.

See Section IV.2.i Project Abstract for content information.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-053 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.

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

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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 HRSA 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 HRSA 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 65 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, 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- 053, 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 65 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-22-053 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.

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

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2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 11: 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 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 and Response (ASPR) website.

Program Requirements and Expectations

The AHEC Program will achieve the overarching program goals and the statutory requirements through the following required activities. Successful applicants must ensure that all activities conform to these requirements.

All AHEC Program activities will be structured around these five focus areas: (A) Educational and Training Activities (B) Strategic Partnership Activities, (C) Statewide Evaluation Activities, (D) AHEC Scholars Program, and (E) Other Requirements:

A. Educational and Training Activities – A critical component of the AHEC investment is the provision of educational and training activities. Applicants must propose educational and training activities that align with the provisions below.

Competitive applicants will prioritize the following:

1. AHEC Scholars Program: Recipients must support the development and implementation of a longitudinal, interdisciplinary program curricula that implements a defined set of clinical didactic, and community-based training activities in rural and/or underserved areas for a cohort of health professions students. For additional requirements, please see the AHEC Scholars Program description at the end of this section.

2. Community-based Experiential Training: Recipients must support community-based experiential training in rural and underserved areas through https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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field placements and clinical rotations for health professions students outside of the AHEC Scholars Program. Each training experience must be team-based and include a formal, didactic component addressing one or more of the Core Topic Areas as identified below (Youth Pipeline activities are exempt from these requirements).

3. Core Topic Areas: Recipients must ensure all educational and training activities support the following eight (8) Core Topic Areas (Youth Pipeline activities are exempt from these requirements):

a. Inter-professional Education (also known as interdisciplinary training), which supports a coordinated, patient-centered model of health care that involves an understanding of the contributions of multiple health care professionals;15

b. Behavioral Health Integration, which promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions.16 To that end, AHEC Program award recipients are also expected to develop behavioral health and paraprofessional training as it relates to addressing clinician burnout and improve provider resiliency. Burnout in health care professionals is widespread and growing; recent studies indicate elevated levels of burnout, along with related conditions of depression and emotional exhaustion. Health care professionals experiencing burnout include physicians, advanced practice registered nurses, registered nurses, dentists, physician assistants, and other health professions.17

c. Connecting Communities and Supporting Health Professionals, which aims to increase training and development of CHWs and paraprofessionals to be the connectors who are able to serve as a liaison/link/intermediary between health professionals and the community to facilitate access to service and improve health equity, community/population health, and social determinants of health.17

d. Virtual Learning and Telehealth, which seeks to improve virtual learning and telehealth curricula and community-based experiential training. The COVID-19 pandemic has forced all health care systems, hospitals, and clinics to rapidly implement telehealth services, simulation-based technology, and virtual trainings to continue delivering patient care.

15 See HRSA’s Coordinating Center for Interprofessional Practice for more information at https://nexusipe.org/.

16 See SAMHSA-HRSA Center for Integrated Health Solutions at http://www.integration.samhsa.gov/.

17 Community Health Workers. Retrieved July 27, 2021 from https://www.apha.org/apha-communities/member-sections/community-health-workers https://nexusipe.org/ http://www.integration.samhsa.gov/ https://www.apha.org/apha-communities/member-sections/community-health-workers https://www.apha.org/apha-communities/member-sections/community-health-workers

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e. Social Determinants of Health (SDOH) are the conditions in the environments where people are born, live learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can be grouped into five (5) domains:

economic stability, education access, and quality; neighborhood and built environment and social and community context.18

f. Cultural Competency, which seeks to improve individual health and build healthy communities by training health care providers to recognize and address the unique culture, language and health literacy of diverse consumers and communities19 (e.g., National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care);

g. Practice Transformation, which aims to fully support quality improvement and patient-centered care through goal-setting, leadership, practice facilitation, workflow changes, measuring outcomes, and adapting organizational tools and processes to support new team-based models of care delivery.20 This includes multi-disciplinary training and infrastructure support on cutting-edge technology, such as data analytics, artificial intelligence and machine learning (AI/ML) to advance health equity and population health. To that end, AHEC Program award recipients are expected to develop and implement educational and training activities and build and strengthen strategic partnerships as designed below. Educational and training activities under practice transformation must target the specific skills and competencies needed to prepare students and practicing health professionals to effectively practice in a transforming health care system; and

h. Current and emerging health issues (e.g., COVID-19, Zika virus, pandemic influenza, opioid use disorder, maternal mortality, geographically relevant health issues, etc.) may be proposed, but will need prior approval from the HRSA program office before implementation.

4. Youth Pipeline Activities: Recipients must support recruitment, training, interactive, and/or didactic activities21 developed for high school students (grades 9-12), which must focus on exposing youth to health careers, 18 See Healthy People 2020 for more information about Social Determinants of Health at https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.

19 See HRSA’s Cultural Competency resources at http://www.hrsa.gov/culturalcompetence/index.html.

20 See also “Natural History of Practice Transformation: Development and Initial Testing of an Outcomes- Based Model.” Ann Fam Med May/June 2013 vol. 11 no. 3 212-219.

21 Pipeline activities may include, but are not limited to, afterschool enrichment activities, community-based outreach and education, pre-college preparation, and pre-certification preparation activities.

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health http://www.hrsa.gov/culturalcompetence/index.html

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including public health. HRSA strongly recommends recipients use no more than 10 percent of the total award for these activities.

5. Continuing Education: Recipients must support didactic and experiential training activities focused on the Core Topic Areas developed for currently practicing health professionals. HRSA strongly recommends recipients use no more than 10 percent of the total award for these activities.

B. Strategic Partnership Activities: Effective partnerships that engage key stakeholders (e.g., federal, state, local, and national organizations) are important to implementing, advancing, and sustaining the work of the AHEC Program.

Partners help to ensure the relevancy, coordination and timeliness of the education and training provided. Partners also serve as connectors to employment and training opportunities in rural and underserved communities.

Highly competitive applicants will establish strategic partnerships with organizations that align with the AHEC Program goals to maximize the impact and outcomes. Such partnering organizations may include:

a. Existing AHEC program…