BHW HRSA-23-004 (D33) PMR_Final 9.20.22.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Bureau of Health Workforce

Division of Medicine and Dentistry

Preventive Medicine Residency

Funding Opportunity Number: HRSA-23-004

Funding Opportunity Type(s): New

Assistance Listings Number: 93.117

Application Due Date: November 21, 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: September 20, 2022

Program Contact Name: Richard Stahlhut, MD, MPH Project Officer, Bureau of Health Workforce Telephone: (301) (301) 287-0058 Email: PMRProgram@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 295c (Section 768 of the Public Health Service Act) mailto:PMRProgram@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 above in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Preventive Medicine Residency Program. The purpose of this program is to increase the number, quality, and diversity of preventive medicine residents and physicians to support access to preventive medicine and to integrate population health with primary care to improve the health of communities.

Funding Opportunity Title: Preventive Medicine Residency (PMR) Program

Funding Opportunity Number: HRSA-23-004

Due Date for Applications: November 21, 2022

Anticipated Total Annual Available

FY 2023 Funding:

$6,700,000

Estimated Number and Type of Award(s): Up to 16 grant(s)

Estimated Annual Award Amount:

Up to $400,000 per award subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: May 1, 2023, through April 30, 2027

(4 years)

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Eligible Applicants: (a) Accredited school of public health or school of medicine or osteopathic medicine;

(b) an accredited public or private nonprofit hospital;

(c) a State, local or tribal health department; or

(d) a consortium of two or more eligible entities as describe in items a, b, or c.

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

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

Technical Assistance HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of the NOFO and provide 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

i. Project Abstract

NARRATIVE GUIDANCE

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Standardized Work Plan (SWP) Form

vi. Attachments

3. 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

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3. Reporting

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: APPLICANT PAGE LIMIT WORKSHEET

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Preventive Medicine Residency (PMR) Program.

For more details, see Program Requirements and Expectations.The purpose of this program is to increase the number, quality, and diversity of preventive medicine residents and physicians to support access to preventive medicine and to integrate population health with primary care to improve the health of communities.

Program Goal

The goals of the PMR program are to 1) increase the supply and diversity of the preventive medicine physicians; and 2) enhance the quality of the preventive medicine residencies through residents having one of their rotations be a longitudinal rotations in a Federally Qualified Health Center (FQHC) in rural and/or medically underserved communities.

Program Objectives

1. Increase the knowledge and skills of preventive medicine residents to incorporate public health competencies into primary care through having one of their rotations be a longitudinal rotation at a FQHC.

2. Increase the knowledge and ability of preventive medicine residents to identify and address social determinants of health (SDOH), low health literacy, and health disparities faced by the populations served by FQHCs.

3. Develop or enhance the curriculum to incorporate teaching regarding emerging public health crises, health equity, health literacy, and strategies to address

SDOH.

4. Increase recruitment and retention of diverse preventive medicine residents and faculty.

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 COVID-19 training.

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2. Background

The Preventive Medicine Residency Program is authorized by Title VII, section 768 of the Public Health Service (PHS) Act, 42 U.S.C. 295c.

“Preventive Medicine is the specialty of medical practice that focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. Preventive medicine specialists have core competencies in biostatistics, epidemiology, environmental and occupational medicine, planning and evaluation of health services, management of healthcare organizations, research into causes of disease and injury in population groups, and the practice of prevention in clinical medicine. They apply knowledge and skills gained from the medical, social, economic, and behavioral sciences.”1

Preventive medicine physicians may naturally fit within health departments since they are trained in the medical specialty of public health; however, that is not the only type of location where preventive medicine physicians practice their specialty.2 Federally Qualified Health Centers (FQHCs) are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality health care services to the nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and veterans.3 Preventive medicine physicians working in these environments can assist organizations in addressing the social determinants of health, health disparities and health literacy faced by the population served. Training preventive medicine residents in FQHCs has the propensity to advance population-based patient outcomes and address health disparities in underserved and rural communities served by these facilities.

The COVID-19 pandemic has demonstrated the value of having the preventive medicine specialist integrated within health systems, including health centers. The integration of public health and primary health care can foster a more holistic understanding of the health needs of the population. This understanding has the potential to decrease health disparities, improve health literacy, and enhance health equity. Preventive medicine physicians’ knowledge of clinical medicine and public health puts them in a position to straddle both, to ensure clinical activities are meeting standards of care, and that public health activities are informed by clinical information.4

1 American Board of Preventive Medicine. (n.d.). The Meaning of Preventive Medicine. Retrieved on May 5, 2022 from http://www.theabpm.org/about-us/.

2 Jung, P., Warne, D., Integration of the Preventive Medicine Specialty in the Rural and Tribal Public Health Workforce, elsevir, Prev Med. 2020 Oct; 139 3 https://bphc.hrsa.gov/about-health-centers/what-health-center 4 Jung, P., Warneb, D., Integration of the Preventive Medicine Specialty in the Rural and Tribal Public Health Workforce, Elsevir, Prev Med. 2020 Oct; 139: 106187, p. 3, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318949/, (accessed 29 December 2021.

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The physician workforce does not resemble the nation’s increasing diverse patient population.5 The Association of American Medical Colleges (AAMC) reports that in 2019 36.3% of the active physician workforce were female and 44.9% of the active physician workforce were age 55 or older.6 Hispanic and African Americans make up 18.5% and 13.4% of the US population respectively, yet only 5.8% and 5% are physicians. Native Americans make up 1.3% of the US population with 0.3% being physicians.7 To provide the best possible care for all patients and help disparities, diversity among physicians is essential.

HRSA has been an important source of federal support for preventive medicine residency programs. HRSA last competed the Preventive Medicine Residency Program in FY 2018. Applicants can review the abstracts of the 17 currently funded projects at the HRSA Data warehouse: https://datawarehouse.hrsa.gov/tools/findgrants.aspx.

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the HRSA Health Workforce Glossary. In addition, the following definitions apply to the PMR Program for Fiscal Year 2023:

Combined Preventive Medicine Programs for the purposes of this NOFO are programs with combined training in Preventive Medicine (PM) and Internal Medicine (IM) that is approved by the American Board of Preventive Medicine (ABPM) and the American Board of Internal Medicine; and combined training in PM and Family Medicine (FM) approved by ABPM and the American Board of Family Medicine.8

Health Equity means the “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.”9

5 Robeznieks, A. How diversity’s power can help overcome the physician shortage. May 18, 2022. Retrieved June 13, 2022 from https://www.ama-assn.org/delivering-care/health-equity/how-diversity-s-power-can-help-overcome-physician-shortage.

6 The Association of American Medical Colleges. 2020 Physician Specialty Data Report; Executive Summary, January 2021. Retrieved June 13, 2022 from https://www.aamc.org/data-reports/data/2020-physician-specialty-data-report-executive-summary.

7 Robeznieks, A. How diversity’s power can help overcome the physician shortage. May 18, 2022. Retrieved June 13, 2022 from https://www.ama-assn.org/delivering-care/health-equity/how-diversity-s-power-can-help-overcome-physician-shortage.

8 https://www.theabpm.org/for-program-directors/combined-training-programs/ 9 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://datawarehouse.hrsa.gov/tools/findgrants.aspx https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.theabpm.org/for-program-directors/combined-training-programs/

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Health Literacy means the degree to which individuals can obtain, process, and understand basic health information and services necessary to make appropriate health decisions.10

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $6,700,000 to be available annually to fund approximately 16 recipients. The actual amount available will not be determined until enactment of the final FY 2023 federal appropriation. Applicants may apply for a ceiling amount of up to $400,000 total cost per year. Your request for each year of the period of performance cannot exceed your year 1 request. 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 May 1, 2023 through April 30, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for PMR in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce or take other enforcement actions regarding recipient funding levels beyond the first year if they are unable to fully succeed in meeting program requirements and expectations as outlined by this application.

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

Limitations on indirect cost rates

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

10 https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/culture-language-and-health-literacy 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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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include:

a. An accredited school of public health or school of medicine or osteopathic medicine;

b. an accredited public or private nonprofit hospital;

c. a state, local or tribal health department; or

d. a consortium of two or more eligible entities as described in items, a, b, or c.

PMR programs must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). An official letter from ACGME must be submitted to HRSA with the application to document the approved accreditation status of the program with the beginning and ending dates of the current accreditation.

Accreditation documentation must be submitted as Attachment 1.

Eligible applicants include public and private nonprofit entities. Faith-based and community-based organizations, Tribes, and tribal organizations are eligible to apply if they meet the eligibility requirements specified in items a through d.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it:

• Exceeds the ceiling amount of $400,000 per year, including both direct and indirect costs, or

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

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). Such federal funds are intended to supplement, not supplant, existing non-federal expenditures for such activities. Complete the Maintenance of Effort (MOE) information and submit as Attachment 4.

HRSA will enforce statutory MOE requirements through all available mechanisms.

NOTE: Multiple applications from an organization are allowed if the applications reflect different specialty areas (public health and general preventive medicine, aerospace medicine, and occupational medicine). An applicant cannot submit more than one

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application for each specialty area. Each application will be evaluated and scored independently.

An organization is defined by having a Unique Entity Identifier. If an organization submits multiple applications under the same specialty area, only the last application that is validated by Grants.gov prior to the deadline will move forward.

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.

Eligible Trainees

Trainees receiving support from award funds must be:

(a) a citizen, national, or permanent resident of the United States; an individual lawfully admitted for permanent residence to the United States, or any other “qualified alien” under section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996” and

(b) a physician who has graduated from a school of medicine accredited by the Liaison Committee on Medical Education (LCME) or a school of osteopathic medicine accredited by the Commission on Osteopathic College Accreditation (COCA) or a non-U.S. physician or graduate of non-U.S. medical schools certified by the Educational Commission for Foreign Medical Graduates (ECFMG).

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 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-23-004 in order to receive notifications https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

2. Content and Form of Application Submission

Application Format Requirements

Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the 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 Limit The total size of all uploaded files included in the page limit shall not exceed the equivalent of 80 pages when printed by HRSA.

Forms that DO NOT count in the Page Limit

• Standard OMB-approved forms included in the workspace application package do not count in the page limit. The abstract is the standard form (SF) "Project_Abstract Summary.” It does not count in the page limit.

• The Indirect Cost Rate Agreement does not count in the page limit.

• The proof of non-profit status (if applicable) does not count in the page limit.

If there are other attachments that do not count against the page limit, this will be clearly denoted in Section IV.2.vi Attachments.

It is important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 80 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-23-004 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, https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

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

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment(s) 8-15: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations

Programs must:

1. Have residents in place during the first budget year. This NOFO does not support a planning year.

2. Provide residents with a longitudinal rotation of a minimum of two months within a Federally Qualified Health Center (FQHC) along with coursework in public health, health management and policy, population and community health, and leadership.

The rotations at the FQHCs will focus on needs assessment of the population served, other projects related to SDOH, and/or analyses of health outcomes data related to the population served by the FQHC.

3. Have residents conduct scholarly research projects on factors affecting the health of the population served by the FQHC rotation.

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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4. Ensure preventive medicine residents apply for a National Provider Identifier (NPI) number, and collect and report the NPI numbers of residents who participate in the program.

5. Develop and implement a plan to collect post-graduation employment data of graduates from the residency program for one-year after completion of the residency.

Program-Specific Instructions 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 that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. See Form Alert in Section IV.1 of this NOFO. For information 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. A brief overview of the project as a whole.

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

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

4. A statement on the projected number of residents to be trained each year and the core specialty(ies) of preventive medicine (i.e., public health and general preventive medicine, occupational medicine, or aerospace medicine) for which support is requested.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Purpose and Need (1) Purpose and Need http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Narrative Section Review Criteria

Response to Program Purpose:

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

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

Budget and Budget Justification Narrative

(5) Support Requested

ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

Use the following section headers for the narrative:

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

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that trainees would ultimately serve. Use and cite demographic data whenever possible to support the information you provided.

1. You must briefly describe the purpose of the proposed project that aligns with the program goals, objectives and requirements in this NOFO. Include the specialty(ies) in preventive medicine for which support is being requested.

2. Outline the needs of the training program or institution. You must describe and document the need for the preventive medicine physicians you propose to train and your institution’s training needs for preventive medicine residents.

3. Include a discussion of the target population served by your preventive medicine residency program, including the socio-cultural determinants of health and health disparities impacting the population or communities served and/or unmet.

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4. Describe the need to incorporate training to increase the use of culturally and linguistically appropriate services, and the need to address public health inequities and health disparities and the principles of SDOH throughout the program or curriculum.

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

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

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

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. Your work plan must be submitted through the Standardized Work Plan (SWP) form located in the Grants.gov workspace. The SWP form is organized by budget period and must include all activities and deliverables for each objective and program goal. The program goals for this NOFO must be entered in the Program Goals section of the SWP form. For example, Goal 1 in the Purpose section of the NOFO will need to be entered as Goal 1 in the SWP form. Objectives and sub-objectives can be tailored to your project needs. Objectives may be tagged with organizational priorities by selecting applicable priorities on the SWP form. For the purpose of this NOFO, please write in COVID-19 or Health Equity in the “Other Priority Linkage” if your objective or sub-objectives align with those priorities. Form instructions are provided along with the SWP form, and are included in the application package found on Grants.gov.

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

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

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

3. Explain how the work plan is appropriate for the program design and how it is specially designed to fit into the overall timeline of grant implementation.

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

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5. If funds will be subawarded or expended on contracts, describe how your organization will ensure the funds are properly documented.

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

You must describe your objectives and proposed activities, and provide evidence for how they relate to the project purpose and stated needs. Discuss the proposed methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO.

You must:

1. Describe your strategy for developing and implementing longitudinal rotations of residents at FQHC (minimum of 2 months) along with coursework in public health, health management and policy, population and community health and leadership.

2. Explain the strategies that will be implemented to increase the supply and diversity of the preventive medicine residents and faculty at your institution.

3. As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve patients, families, and communities.

4. If applicable, include a plan to disseminate reports, products, and/or project outputs so that key target audiences receive the project information.

5. Provide a training table as Attachment 5 that includes:

a. the total number of preventive medicine resident slots in your program, by specialty;

b. the projected number of residents trained by specialty and funded per year by this grant program;

c. the projected number of residents by specialty trained, but not supported by this grant program; and

d. the projected number of graduates funded by this program for each year of the period of performance.

Example:

Year Total Number of PM Residents Slots in Program

Total Number of Residents by Specialty Trained and Funded by this Program

Total Number of Residents by Specialty Trained by Specialty and Not Funded by this Program

Projected Number of PM Funded Residents Expected to Graduate

Year 1 Year 2 Year 3

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Year 4

6. Describe any key partner programs, departments, and organizations involved in the project and how you will function and coordinate carrying out the grant activities. Specifically describe rotations with governmental public health agencies and other public health practice partners. Provide letters of agreement, memorandums of understanding, and descriptions of proposed or existing contracts in Attachment 6. Attach letters of support in Attachment 7.

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

Criterion 2 (c)

1. Describe the challenges you may encounter in achieving the program specific requirements including having residents in place during the first budget year.

2. Describe the challenges and obstacles in regard to the program implementation and activities outlined in the work plan, and demonstrated resources to overcome these challenges for the achievement of the proposed goals and objectives.

3. Describe challenges in locating and providing longitudinal rotations for residents in a FQHC.

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

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

Describe the evaluation measures to assess: 1) the extent to which the program objectives have been met; and 2) the extent to which these can be attributed to the project.

1. Describe how project faculty/staff demonstrate the technical capacity to conduct the evaluation of the project including evaluation of outcomes matched to prevailing quality measures.

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

3. Describe the plan for program performance evaluation including your plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of

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necessary adjustment to planned activities to effect course corrections. You may choose to require RCQI as part of an activity to be included under some or all program objectives and submitted in the SWP.

• Include descriptions of the inputs (e.g., key evaluation personnel and organizational support, collaborative partners, budget, and other resources); key processes; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported.

• Additional information on RCQI is available at the following website:

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

4. Describe the systems and processes that will support your organization's collection of HRSA’s performance management requirements through effective tracking of performance outcomes, including a description of how the organization will collect and manage data (e.g., assigned skilled staff, data management software) in a way that allows for accurate and timely reporting of performance outcomes. At the following link, the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html. Sample data points that you may be required to collect include—but are not limited to—the following:

a. Number, specialty, and demographics of residents for each year of the grant (including, year of birth, gender, ethnicity, and race).

b. Number of residents from a disadvantaged background.

c. Number of residents from a rural area.

d. Number and duration of rotations in FQHCs.

e. Number of residents who train in rural, medically underserved communities and in primary care settings.

f. Number of curriculum development offerings created by the grant each year of the grant and number of individuals participating in each offering.

5. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

6. Document the procedure for assuring the data collection, management, storage, and reporting of NPI numbers for individuals participating in the Program. Describe your process to track trainees after program https://www.healthworkforceta.org/wp-content/uploads/2016/06/RCQI_Resource_Guide.pdf https://www.healthworkforceta.org/wp-content/uploads/2016/06/RCQI_Resource_Guide.pdf http://bhw.hrsa.gov/grants/reporting/index.html

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completion/graduation for up to 1 year, to include collection of trainees’ NPIs.

(Note: Trainees who receive HRSA funds as a result of this award are required to apply for an NPI for the purpose of collecting post-graduation employment demographics).

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

1. Provide a specific sustainability plan for exploring future sources of potential funding for support for the PMR program.

2. Propose timetable for becoming self-sufficient.

3. Describe challenges that are likely to be encountered in sustaining the program and propose approaches that will be used to resolve these challenges.

4. Describe how the plan addresses sustaining key elements of the supported activities such as educational strategies, partnerships, tangible next steps for continuing the project activities, and evaluation beyond the duration of the project.

ORGANIZATIONAL INFORMATION, RESOURCES, AND CAPABILITIES --

Corresponds to Section V’s Review Criterion 4

Succinctly describe your organization’s current mission, structure, and scope of current activities and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations.

1. Demonstrate that project personnel are qualified by training and/or experience to implement and carry out the project; this will be evaluated both through the project narrative, as well as through the key personnel biographical sketches and attachments.

2. Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project.

3. Describe your organization’s current mission, structure, and scope of current activities and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations. Provide an organizational chart as Attachment 3.. Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

4. Provide evidence of institutional support such as letters of agreement and support, in kind contribution of faculty, staff and resources, other partners providing support, as provided in Attachments 2 (Staffing Plan and Job Description for Key Personnel) and 3 (Project Organizational Chart).

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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 (Expanded) 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 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 them particularly well-suited for their 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 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

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overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

iii. Budget The directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 R&R Application Guide and the additional budget instructions provided below. A budget that follows the R&R Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

If applicable (i.e., competitions with subawards/subcontracts), each subaward/subcontract requires separate budget information (i.e., line item budget form and budget justification narrative):

Subawards/subcontracts

A detailed line-item budget form is required for each subaward and should be uploaded to the R&R Subaward Budget Attachment(s) Form.

The R&R Subaward Budget Attachment Form limits the number of attachments for subawards to 10. If you need to include additional line-item budget forms, upload the attachment in R&R Other Project Information Form, block 12 “Other Attachments.” These additional line-item budget forms for subawards will not count against the page limit.

Note that any additional budget justifications (i.e., back-up information) are included in the page limit.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and costs borne by you to satisfy a matching or cost-sharing requirement, as applicable.

As required by the Consolidated Appropriations Act, 2022 (P.L. 117-103), “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.” See Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 R&R Application Guide for additional information. Note that these or other salary limitations may apply in the following fiscal years, as required by law.

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

iv. Budget Justification Narrative See Section 4.1.v of HRSA’s SF-424 R&R Application Guide.

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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The budget justification narrative must describe all line-item federal funds (including subawards), and matching non-federal funds proposed for this project. Please note: all budget justification narratives count against the page limit. In addition, PMR requires the following:

Resident Support Costs: List tuition/fees/health insurance, stipends, travel, subsistence, other expenses, and the number of residents.

Resident costs are to be obligated at the start of an individual resident’s training year. Budget periods for this grant program are expected to be May 1 through April 30. A resident that starts, for example, on July 1, in the middle of an annual budget period, must have the full 2 years of trainee costs obligated at that time.

Combined programs (e.g., Internal Medicine/Preventive Medicine or Family Medicine/Preventive Medicine) may provide stipends proportionally while the resident is in the preventive medicine residency part of the combined program only.

Applicants must specify in the application when they are supporting combined preventive medicine residency programs and when in the program the preventive medicine training occurs.

Ensure that your budget breakdown separates these resident costs, and includes a separate sub-total entitled “Total Participant/Trainee Support Costs” which includes the summation of all resident costs.

Infrastructure: List residency program infrastructure and faculty costs, including faculty time and development activities.

Consultant Services: If you are using consultant services, list the total costs for all consultant services. In the budget justification, identify each consultant, the services they will perform, the total number of days, travel costs, and the total estimated costs.

v. Standardized Work Plan (SWP) Form As part of the application submitted through Grants.gov, you must complete and electronically submit the SWP Form by the application due date. Work Plan -- Corresponds to Section V’s Review Criterion 2 (a).

The SWP Form is part of the electronic Grants.gov application package and must be completed online as a part of the Grants.gov application package. Ensure it includes all the information detailed in Section IV.2.ii. Project Narrative.

vi. Attachments Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limitation. Your indirect cost rate agreement and proof of non-profit status (if applicable) will not count toward the page limitation. Clearly label each attachment.

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You must upload attachments into the application. Any hyperlinked attachments will not be reviewed/opened by HRSA.

Attachment 1: Accreditation Documentation (Required) You must provide:

(1) a statement that you hold…