BHW HRSA-22-105 (T9C)_THCGME_Final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Teaching Health Center Graduate Medical Education (THCGME) Program

Funding Opportunity Number: HRSA-22-105

Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.530

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: September 21, 2021

SAM.gov and Grants.gov administrative flexibilities have been implemented.

Please see Section IV.3 for more information.

Issuance Date: July 23, 2021

Kristin Gordon Project Officer, Division of Medicine and Dentistry Bureau of Health Workforce, HRSA Telephone: (301) 443-0337 Email: KGordon@hrsa.gov

Authority: Section 340H of the Public Health Service (PHS) Act (42 U.S.C. 256h), as amended and Section 2604 of the American Rescue Plan Act of 2021 (P.L. 117-2).

mailto:KGordon@hrsa.gov

HRSA-22-105 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Teaching Health Center Graduate Medical Education (THCGME) Program. The THCGME Program provides funding to support the training of residents in primary care residency training programs in community-based ambulatory patient care centers. Payments will be made for the following: (1) expansion awards to support an expanded number of resident FTE positions at existing HRSA THCGME Programs, and (2) new awards to support new resident FTE positions at new Teaching Health Centers (THCs). New THCs are applicants that have never received payment under the HRSA THCGME Program for the applicable residency program.

Funding Opportunity Title:

Teaching Health Center Graduate Medical Education (THCGME) Program

Funding Opportunity Number: HRSA-22-105 Due Date for Applications: September 21, 2021 Anticipated Total Available FY 2022 Funding:

$45,920,000

Estimated Number and Type of Award(s): Up to 85 awards (35 expansion awards, and 50 new awards)

Estimated Award Amount: Award amounts are formula based, calculated from the number of awarded resident full-time equivalents (FTEs)

Cost Sharing/Match Required: No Period of Performance:

July 1, 2022 through June 30, 2026 (Four (4) years)

Eligible Applicants: An eligible entity is a community-based ambulatory patient care center that sponsors an accredited primary care residency program in one of the following specialties/disciplines:

• Family Medicine

• Internal Medicine

• Pediatrics

• Internal Medicine-Pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

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

HRSA-22-105 ii.

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 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/ 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/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

III. ELIGIBILITY INFORMATION

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. Resident FTE Request Justification Narrative

v. 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

2. REVIEW AND SELECTION PROCESS

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: ASSURANCES DOCUMENT

APPENDIX B: ELIGIBLE RESIDENT/FELLOW FTE CHART

HRSA-22-105 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Teaching Health Center Graduate Medical Education (THCGME) Program.

Program Purpose The purpose of the THCGME Program is to support the training of residents in primary care residency training programs in community-based ambulatory patient care centers.

Programs will prepare residents to provide high quality care, particularly in rural and underserved communities, and develop competencies to serve these diverse populations and communities. Two award types are available:

1. Expansion awards for an expanded number of resident FTE positions at existing HRSA THCGME Programs.

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

Awards made through this announcement may be utilized to support the costs associated with resident FTE training only. THCGME Program funds may not be used for residency program development (e.g. the costs associated with accreditation).

Applicants interested in applying for development funds to achieve accreditation to begin a new community-based primary care residency program should refer to the FY 2021 Teaching Health Center Planning and Development (THCPD) NOFO (HRSA-21- 138), which is accessible via Grants.gov.

Program Goals To achieve this purpose, the THCGME Program provides to THCs a per-resident payment established by HRSA inclusive of both Direct Medical Education (DME) and Indirect Medical Education (IME) expenses.

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

The sponsoring institution of the residency program, as listed by the relevant accrediting body defined later in this NOFO, must be a community-based ambulatory patient care center or a Graduate Medical Education (GME) consortium, as defined in Section III of this NOFO. Teaching hospitals and academic institutions are not eligible recipients of THCGME funding.

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

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1. Expansion – Existing HRSA THCGME programs requesting expansion of resident FTEs may request support for an expanded number of resident FTEs beyond the number stated in your most recent HRSA THCGME Program Resident FTE Approval Letter.

2. New THCs – must demonstrate that the number of resident FTE(s) being requested is above the program’s baseline. The baseline is the highest number of resident FTEs trained by the program in any of the last four (4) academic years (AY 2018-2019 through AY 2021-2022). Training of newly supported THCGME residents must start in AY 2022-2023.

New THCs that are currently training residents may request resident FTEs for THCGME support; however, all requests must be above the program’s resident FTE baseline, as documented in your Eligible Resident/Fellow FTE Chart (Attachment 5) and must not put the program above the number approved by the relevant accrediting body, as documented in Attachment 6. THCGME funding may not be used to support resident FTE positions below your program’s baseline, as described above. In addition, resident FTE positions supported by other federal GME sources of funding may not be substituted with THCGME funds.

Organizations intending to apply for more than one residency program should refer to the information on “Multiple Applications” in Section III.3 Eligibility.

Statutory Funding Priorities This notice includes funding priorities for making awards to new THCs as defined in Section 340H(a)(3) of the PHS Act [42 U.S.C. 256h(a)(3)]. Up to 15 points are available across three (3) funding priorities for new THC applicants that qualify. New THC applicants are permitted to apply for more than one priority. Applicants for new THC awards may also apply to this announcement without requesting a funding priority.

Instructions and criteria for each funding priority are provided in Section V.2.

2. Background

The THCGME Program is authorized by Section 340H of the PHS Act [42 U.S.C.

256h].

The National Center for Health Workforce Analysis (NCHWA) projects that the total demand for primary care physicians will grow by 38,320 FTEs between 2013 and 2025.

It is estimated that there will be a shortage of 23,640 primary care physician FTEs by

2025.1 The NCHWA also notes that the demand for dentists is projected to grow by 20,400 FTEs – from 197,800 in 2012 to 218,200 in 2025 - a 10 percent increase in need. Moreover, all 50 states and the District of Columbia are projected to experience a

1 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA. “National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025”. November 2016.

Available at: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf.

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shortage of dentists.2 In addition to overall shortages, there is maldistribution of primary care providers with rural and other underserved communities experiencing the greatest shortages.

The THCGME Program was authorized by Section 340H of the PHS Act [42 U.S.C.

256h] in response to the nation’s growing need for primary care services and as a new model for GME focused on primary care physician and dentist training in ambulatory care settings. The Medicare Payment Advisory Commission (MedPAC) and other stakeholders have called for increasing the amount of GME time spent in nonhospital settings, making changes to GME funding to advance goals such as increasing community-based care, and increasing the diversity of the pipeline of health professionals.3

The THCGME Program aims to strengthen the primary care workforce by supporting medical and dental training programs in primary care, community-based settings with an emphasis on improving the distribution of this health workforce in rural and underserved communities. The program focuses on a different model for resident education than most other federally funded models of GME, which are predominantly located in large, urban academic medical centers. This model was developed based on evidence showing that family medicine resident physicians who train in health center settings are nearly three times as likely to practice in underserved settings after graduation when compared to residents who did not train in health centers.4 There is also evidence that physicians who receive training in community and underserved settings are more likely to practice in similar settings, such as health centers.5,6

The THCGME Program is providing a vital supply line to support the primary care health workforce demand. Since the program began in FY 2010, the THCGME Program has graduated 1,434 new primary care physicians and dentists. 7 THCGME residents have provided over 3.5 million hours of patient care in primary care settings during 3.1 million patient encounters. Additionally, residents have provided over 5.5 million hours of patient care in medically underserved and rural settings, significantly expanding access to care in these key settings.

While the national average for physicians going into primary care is approximately 33 percent, the THCGME Program has evidenced much stronger results. Cumulative follow-up data indicates that 65 percent of THCGME-funded graduates are currently

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA. “National and State-Level Projections of Dentists and Dental Hygienists in the U.S., 2012-2025”. February 2015. Available at:

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nationalstatelevelprojectionsdentists.pdf.

3 Report to the Congress: Aligning Incentives in Medicare (June 2010). Medicare Payment Advisory Commission.

(Available at http://www.medpac.gov).

4 Morris CG, Johnson B, Kim S, and Chen FM. Training Family Physicians in Community Health Centers: A Health Workforce Solution. Family Medicine. 2008; 40(4):271-6.

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

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

1313–1321.

7 Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. THCGME Program Academic Year 2019-2020 Highlights. Available at:

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/thcgme-outcomes-2019-2020.pdf.

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practicing in a primary care setting and approximately 56 percent of the THCGME-funded graduating physicians and dentists are currently practicing in a medically underserved community and/or rural setting. In Academic Year 2019-2020, nearly all THCGME-funded residents (over 99 percent) received training in a primary care setting, providing care during more than half a million patient encounters and accruing nearly 600,000 contact hours with these primary care patients. Additionally, the majority of THCGME-funded residents (93 percent) spent a significant part of their training in medically underserved and/or rural communities, providing over 1.1 million hours of patient care.

Expanding the number of primary care residents who train in community-based ambulatory patient care centers will have a direct impact on increasing healthcare providers in rural and underserved areas. It is part of the Administration’s commitment to addressing longstanding health inequities and expanding the pipeline of health care providers serving rural and underserved communities.

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

Approved graduate medical residency training program means (as defined in section 340H(j)(1) of the PHS Act [42 U.S.C. 256h(j)(1)]) a residency or other postgraduate medical training program: 1) participation in which may be counted toward certification in a specialty or subspecialty and includes formal postgraduate training programs in geriatric medicine approved by the Secretary; and 2) that meets criteria for accreditation as established by the Accreditation Council for Graduate Medical Education or the American Dental Association’s Commission on Dental Accreditation.

Existing THC means an “approved graduate medical residency training program” as defined in section 340H(j)(1) of the PHS Act [42 U.S.C. 256h(j)(1)]) sponsored by an eligible entity that received a payment under the HRSA THCGME Program for a previous fiscal year.

Full-Time Equivalent (FTE) is the ratio of a resident’s time required to fulfill a full-time residency slot for one Academic Year. Multiple individuals’ FTE time can sum to equal one full-time resident.

GME consortium means a collaboration between a community-based, ambulatory patient care center and community stakeholders (e.g., academic health centers, universities and/or medical schools, teaching hospitals), to form an entity that serves as the institutional sponsor of, and operates, an accredited primary care residency program. The community-based ambulatory patient care center plays an integral role in the academic, financial, and administrative operations of the residency program, as well as in the academic and clinical aspects of the program including, but not limited to:

curriculum development, scheduling of clinical rotations, and selection of staff and residents. The relationship between the THC and the consortium must be legally binding, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

https://bhw.hrsa.gov/glossary

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

Reconciliation means the annual process for determining changes to the number of FTEs reported by a THC in its application, compared to its actual use of FTEs during the most recently completed budget period, to determine the final amount payable for both DME and IME. This process is utilized to recoup overpayments pursuant to section 340H(f) of the PHS Act [42 U.S.C. 256h(f)].

Teaching Health Center (THC) means (as defined in section 749A(f)(3) of the PHS Act [42 U.S.C. 293l-1(f)(3)]) a community-based, ambulatory patient care center that operates a primary care residency program, including, but not limited to: Federally qualified health centers (FQHCs); community mental health centers (CMHCs); rural health clinics; health centers operated by the Indian Health Service (IHS), by tribes or tribal organizations, or by urban Indian organizations; and, entities receiving funds under Title X of the PHS Act.

II. Award Information

1. Type of Application and Award

Types of applications sought: New

Note: Existing HRSA THCGME Programs applying for resident FTE expansion must submit a new application for the requested additional resident FTEs in Grants.gov under HRSA-22-105.

HRSA funding will be provided in the form of a formula-based payment.

2. Summary of Funding

HRSA expects approximately $45,920,000 to be available to fund approximately 85 awards (35 expansion, and up to 50 new awards). The period of performance is July 1, 2022 through June 30, 2026 (4 years). Funding beyond FY 2022 is dependent on satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

The FY 2022 THCGME Program payment is formula-based and provides a payment inclusive of both DME and IME support. The final payment methodology for the THCGME Program has not yet been established. The FY 2022 interim payment rate will be $160,000 per resident FTE. In subsequent fiscal years, the payment rate may change due to available appropriations and/or changes in payment methodology.

Reconciliation All THCGME funding is subject to annual reconciliation (see section 340H(f) of the PHS Act [42 U.S.C. 256h(f)]). During reconciliation, any changes to the number of

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residents reported by the award recipient will be calculated in order to determine a final amount payable for the budget period.

Awardees are responsible for the accuracy of FTE data submitted to HRSA and may be audited by HRSA to ensure the accuracy and completeness of the information submitted. In addition, Section 340H(e) of the PHS Act [42 U.S.C.

256h(e)] describes the relationship between THCGME Program funding and GME payments made by Medicare and the Children’s Hospital Graduate Medical Education Payment (CHGME) program. If a resident FTE’s time is submitted to Medicare or the CHGME program for the purposes of receiving payment, the THC cannot also claim that same time for payment from the THCGME Program. HRSA requires applicants to coordinate closely with affiliated teaching hospitals in order to avoid over-reporting of THCGME supported FTE positions. Over-reporting of FTEs, including ineligible FTEs, and subsequent over-payment will result in the recoupment of THCGME payments.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants must meet all of the following criteria in order to be considered eligible for THCGME funding. Applicants that fail to meet any eligibility criteria will not be considered for funding under this announcement.

A. Eligible Entities An eligible entity is a community-based ambulatory patient care center that:

i. Operates an accredited primary care residency program. Specific examples of eligible outpatient settings include, but are not limited to:

• Federally qualified health centers, as defined in section 1905(l)(2)(B) of the Social Security Act [42 U.S.C. 1396d(l)(2)(B)];

• Community mental health centers, as defined in section 1861(ff)(3)(B) of the Social Security Act [42 U.S.C. 1395x(ff)(3)(B)];

• Rural health clinics, as defined in section 1861(aa)(2) of the Social Security Act [42 U.S.C. 1395x(aa)(2)];

• Health centers operated by the Indian Health service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act [25 U.S.C. 1603]); and

• A community-based entity receiving funds under Title X of the PHS Act.

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

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The list of entities above is not exhaustive, but does reflect the intent of the program to provide training in settings such as those served by the institutions listed.

OR

ii. Has collaborated to form a GME consortium that operates an accredited primary care residency program.

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

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

Within the consortium, the community-based ambulatory care center is expected to play an integral role in the academic, financial and administrative operations of the residency. THCGME payments must be used to support resident training and clinical activities at the ambulatory training site.

Applicants applying as part of a GME consortium must maintain the consortium throughout the award period of performance. The applicant is the entity that meets the agency's or program's eligibility criteria and has the legal authority to apply and to receive the award. In the event of an organizational change that will affect the training program’s financial, academic or operational function or organization, awardees must notify HRSA and submit a prior approval request for the change through HRSA Electronic Handbooks (EHB) system.

B. Eligible Primary Care Residency Programs

Only specific residency training programs are eligible. “Primary care residency program” (as defined in section 340H(j)(3) of the PHS Act [42 U.S.C. 256h(j)(3)]) refers to an approved graduate medical education residency training program in:

• Family Medicine

• Internal Medicine

• Pediatrics

• Internal Medicine-pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

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C. Accreditation/Institutional Sponsorship

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

The applicant MUST provide documentation that the residency program is accredited. Accreditation documents must indicate the accrediting body, name the residency program’s institutional sponsor, and the dates of accreditation for verification purposes (see Attachment 6). Applicants that are in the process of obtaining accreditation for their residency program may apply, but they must provide documentation from the appropriate accrediting body demonstrating that the accreditation process has been initiated prior to the September 21, 2021 NOFO application due date. Further, applicants will not receive THCGME program funds if documentation of accreditation is not received by HRSA by November 5, 2021, 11:59pm Eastern. Applicant residency programs must be prepared to begin training residents starting July 1, 2022.

Non-community-based ambulatory patient care settings, such as teaching hospitals, health care systems and/or networks, and academic institutions holding the institutional sponsorship of a primary care residency program are not eligible to receive THCGME funding. Teaching hospitals and academic institutions have proven to be successful partners of THCs and members of established GME consortia. In these cases, the GME consortium must serve as the institutional sponsor of the residency program.

2. Cost Sharing/Matching

Cost sharing or matching is not required.

3. Other

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Page Limit HRSA will consider any application that exceeds the page limit referenced in Section_IV non-responsive and will not consider it for funding under this notice.

Multiple Applications NOTE: Multiple applications from an organization are allowable. Entities seeking THCGME funding to support multiple residency programs MUST submit a separate application for each individual residency program. If an entity is submitting multiple

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applications for different residency programs, please include a unique name for each training program in the project abstract to differentiate between applications.

Existing HRSA THCGME Programs applicants requesting to expand the number of resident FTEs in their program must submit a new application for the additional resident FTEs requested for each HRSA THCGME individual residency program.

HRSA will only accept your last validated electronic submission for each specifically identified residency program, under the correct funding opportunity number, prior to 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.

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 each NOFO you are reviewing or preparing in the workspace application package 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

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. 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 Limit 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 abstract, 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 https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-rr-app-guide.pdf

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project narrative, resident FTE request justification narrative, attachments including biographical sketches (biosketches), and letters of commitment and support required in the 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 "Project_Abstract Summary.” Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Note:

If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-105, 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 the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) Where you are unable to attest to the statements in this certification, 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.

Program-Specific Instructions

Program Requirements

A. Application Process for Existing HRSA THCGME programs Requesting Expansion of Resident FTEs and New THC Applicants

In accordance with Section 4 of HRSA’s SF-424 R&R Application Guide, existing THCs requesting expansion of resident FTEs and new THCGME applicants must submit the following:

1. SF-424 R&R Application Package

2. A project abstract

3. A project narrative

4. A resident FTE request justification narrative

5. Work Plan (Attachment 1) http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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6. Staffing Plan and Job Descriptions for Key Personnel (Attachment 2)

7. Letters of Agreement from all major training partners, including required formal agreements from hospital partners (Attachment 3)

8. Residency Program Organizational Chart (Attachment 4)

9. Resident FTE chart (Attachment 5)

10. Accreditation documentation, including any potential citations (Attachment 6)

11. Request for Funding Priorities – if new THC applicant is requesting funding priorities (Attachment 7)

12. Letters of Support (Attachment 8)

13. THCGME Program Assurances (Attachment 9)

B. THCGME Application Component Descriptions Applicants must submit the following components to complete their application submission. Sections marked as “All Applicants” must be completed by existing THCs requesting expansion of resident FTEs and new THC applicants.

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. For information content required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. Name of the training program;

2. Discipline of the residency program;

3. Type of application Expansion or new THCGME applicant ;

4. Eligible Entity type - state the type and name of community-based ambulatory patient center based on Section III, A. Eligible Entities, and whether the community-based ambulatory patient care center operates the residency program alone or as part of a GME consortium;

5. Year program first began training residents;

6. Organization website address;

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

8. Total FTE positions requested to be funded under this program for all years of training, e.g., 12 (4-4-4) resident FTE; and

9. FTE positions requested to be funded under this program for AY 2022-2023;

e.g., 4 (4-0-0).

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ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory 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:

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

Briefly describe the purpose and mission of the applicant residency program.

Describe the population served by the community-based ambulatory patient care site(s) that will host the residency program and the need for primary care providers in your community. You must also state the number of resident FTE(s) you are requesting for THCGME support. Describe how your residency program is expected to improve the workforce and improve health in your community.

Provide data where available.

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).

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

You must provide a detailed work plan in Attachment 1 that demonstrates your experience implementing a primary care residency program (a sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.).

You must:

• Describe the timeframes, deliverables, and key partners required during the period of performance to implement the residency program as described in the Methodology section.

• 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 have the necessary competencies to serve the cultural, racial, linguistic and/or geographic diversity of the relevant populations and communities.

• Describe how your organization will ensure the funds are properly documented if funds will be sub-awarded or expended on contracts.

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

Describe your current accreditation status. If you are in the process of applying for residency program accreditation and/or approval of program expansion with the relevant accrediting body, describe the steps you have taken to ensure that ACGME http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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or CODA approval will be obtained, and documentation provided to HRSA, by the November 5, 2021 deadline specified in this NOFO. Describe the steps that you have taken to ensure that your residency program is operational in AY 2022-2023. Provide accreditation documentation in Attachment 6.

Describe your residency program education and training curriculum, including how your program will prepare graduates for careers in primary care in rural and underserved areas. Please highlight any unique aspects of training at the program, and additionally any training in the following areas: high-need communities or populations served by the program, mental health, substance/opioid use disorders, public health, community medicine, rural health, and telehealth.

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

Describe your plans to recruit high quality residents who demonstrate a commitment to practice in rural and underserved communities and to develop competencies to serve diverse populations and communities, as described in the Purpose and Needs section.

For previously existing non-THCGME residency programs, please describe historical program outcomes including your program’s graduate retention and placement in Health Professional Shortage Areas (HPSAs), Medically Underserved Communities (MUCs) and/or rural areas. Describe how patient care and healthcare delivery has changed within your training site(s) as a result of the pandemic and your plans to incorporate these new models into resident training.

(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.

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)

You must 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. Describe the data collection strategy to collect, manage, analyze and track 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 http://bhw.hrsa.gov/grants/reporting/index.html

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reporting of performance outcomes. Describe any potential obstacles for fulfilling HRSA’s performance measurement reporting requirements and your plan to address those obstacles.

Describe your plan to track the practice patterns of graduates for five years following the completion of their residency training.

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

You must provide a clear plan for project sustainability, including a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; and (b) obtain future sources of potential funding, as needed. Describe any additional sources of funding your residency program has or is expected to receive in the future.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed residency program. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations. A residency program organizational chart should be provided in Attachment 4.

The organizational chart should clearly identify the eligible community-based ambulatory patient care setting, the sponsoring institution, and all relevant partners, including training partners, required for the residency program.

Letters of agreement from all major training partners should be included in Attachment 3. Additional letters of support may be submitted in Attachment 8.

If you are collaborating with a hospital for training, you must enumerate the steps that will be taken to ensure that resident FTEs submitted to the THCGME Program will not also result in Medicare GME or CHGME Program payments.

The letter of agreement from any hospital partners should clearly delineate the organization’s understanding and plan to ensure there is no double payment for the same FTE.

If your organization is applying as part of a GME consortium the following information must be included in this section:

• List all members of the GME consortium.

• Describe the community-based ambulatory patient care center’s operational and financial responsibilities for the residency program.

• Describe the funding flow between members of the consortium as well as how spending and budgetary decisions are made.

• Describe the roles members play concerning the:

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o Selection of trainees o Selection of faculty o Development of rotation schedules o Development of the curriculum

Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 2 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile form that can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with health disparities and cultural and linguistically diverse populations that are served by their programs.

Biographical sketches, not exceeding two pages per person, should include the following information:

• Senior/key personnel name

• Position Title

• Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online

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format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

• Section D (optional) Other Support. List both selected ongoing and completed (during the last 3 years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

iii. Budget

The THCGME Program is a formula-based payment program that does not require submission of a formal budget. However, a justification for the number of resident FTEs requested by existing THC expansion applicants and new applicants is required and described below. Please note that the SF-424 R&R submission package contains budget forms that are required to be submitted. Applicants are advised to put in a “0” for this form and then upload a blank document as an attachment to complete the package.

HRSA’s Standard Terms apply to this program. Please see Section 4.1 of HRSA’s SF- 424 Application Guide for additional information. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II. The current Executive Level II salary is $199,300. See Section 5.1.iv Budget – Salary Limitation of HRSA’s SF-424 Application Guide for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

iv. Resident FTE Request Justification Narrative.

The number of resident FTEs requested will determine your THCGME funding amount.

You must provide a justification for the number of resident FTEs you are requesting.

Describe how the additional FTEs will address the needs of your program and the community your program serves. A strong justification will be supported by data and examples, account for accreditation requirements, and be directly related to the Purpose and Need section.

For existing THCs requesting expansion of resident FTEs, the resident FTE number requested should be above the number stated in your most recent HRSA THCGME Program Resident FTE Approval Letter. For new THC applicants, the resident FTE number requested must be above your program baseline. See Section I.1. Purpose for details.

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.

Narrative Section Review Criteria Purpose and Need (1) Purpose and Need Response to Program Purpose:

(a) Work Plan

(2) Response to Program Purpose

(a) Work Plan https://www.hrsa.gov/grants/standard-terms https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-rr-app-guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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(b) Methodology/Approach

(c) Resolution of Challenges

(b) Methodology/Approach

(c) Resolution of Challenges

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources and Capabilities

(4) Organizational Information, Resources and Capabilities

Resident FTE Request Justification Narrative (below)

(5) Support Requested.

v. Attachments

Please provide the following items in the order specified below to complete the content of the application. All attachments count toward the application page limit. You must clearly label each attachment.

Attachment 1: Work Plan –All Applicants

Attach the work plan for the project that includes all information detailed in Section IV.2.ii. Project Narrative. If you will make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds.

Attachment 2: Staffing Plan and Job Descriptions for Key Personnel – All Applicants

See Section IV.2.ii. Project Narrative. Keep each job description to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff.

Attachment 3: Letters of Agreement, Memoranda of Understanding, and/or Description(s) of Proposed/Existing Contracts (project-specific) – All Applicants

Provide any documents that describe working relationships between your…