BHW HRSA-23-012 (T23) CHGME_Final for Posting 6.29.22.pdf

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Medicine and Dentistry

Children’s Hospitals Graduate Medical Education (CHGME) Payment Program

Funding Opportunity Number: HRSA-23-012

Funding Opportunity Type(s): New and Competing Continuation

Assistance Listings (AL/CFDA) Number: 93.255

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

PHASE 1: Application Due Date in Grants.gov: August 1, 2022

PHASE 2: Supplemental Information Program Specific Forms Due Date in HRSA EHB: September 1, 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: June 29, 2022

Lisa Flach-Fulcher Budget Analyst, Graduate Medical Education Branch Phone: (301) 443-0365 Email: aflach-fulcher@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 256e (§ 340E of the Public Health Service Act) mailto:aflach-fulcher@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, email or call one of the HRSA staff listed in Section VII. Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Children’s Hospitals Graduate Medical Education Payment Program. The purpose of this program is to fund freestanding children’s hospitals to support the training of pediatric and other residents in graduate medical education (GME) programs.

Funding Opportunity Title: Children’s Hospitals Graduate Medical Education Payment Program

Funding Opportunity Number: HRSA-23-012 Due Date for Applications:

Phase 1: Grants.gov: August 1, 2022 at 11:59 p.m. ET.

Phase 2: HRSA EHBs: September 1, 2022 at 5:00 p.m. ET.

Anticipated FY 2023 Total Annual Available

$332,000,000

Estimated Number and Type of Award(s): Up to 62 program awards

Estimated Award Amount: Formula awards, varies; subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: October 1, 2022 through September 30, 2023 (1 year) Eligible Applicants:

Freestanding children’s hospitals whose inpatients are predominantly under 18 years of age, who participate in an approved GME program, and who have a Medicare provider agreement.

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

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Two-Tier Application Guide, available online at https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf- 424-research-related-2tier-guide-v2.pdf, except where instructed in this NOFO to do otherwise.

Submissions The CHGME Payment Program requires two submissions during the federal FY: (1) an initial application to determine interim payments, and (2) a reconciliation application to finalize the number of full-time equivalent (FTE) resident counts and subsequently determine final payments. CHGME Payment Program awardees applying for the Quality Bonus System (QBS) payment must submit complete individual level documentation for all residents supported by the CHGME Payment Program in the FY 2023 Annual Performance Report (AY 2022-2023). See NOFO Section V.3 Quality Bonus System for more information.

If you fail to comply with all requirements, including federal registrations stated in this NOFO, your application will be deemed non-responsive, and your application will not be considered for funding under this notice. Please note that registration or renewals in SAM.gov and Grants.gov may take up to 30 days to complete.

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

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-research-related-2tier-guide-v2.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-research-related-2tier-guide-v2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. Purpose

2. Background

II. AWARD INFORMATION

1. Type of Application and Award

2. Summary of Funding

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

2. Cost Sharing/Matching

3. Other

IV. APPLICATION AND SUBMISSION INFORMATION

1. Address to Request Application Package

2. Content and Form of Application Submission

i. Program-Specific Forms

ii. Attachments

3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

4. Submission Dates and Times

5. Funding Restrictions

V. APPLICATION REVIEW INFORMATION

1. Review Criteria

2. Review and Selection Process

3. Quality Bonus System (QBS) Payment

4. Assessment of Risk

VI. AWARD ADMINISTRATION INFORMATION

1. Award Notices

2. Administrative and National Policy Requirements

3. Reporting

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: A

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Children’s Hospitals Graduate Medical Education (CHGME) Payment Program.

The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal GME funding for freestanding children’s teaching hospitals versus other types of teaching hospitals. Federal funding for graduate medical education (GME) is primarily provided by the Centers for Medicare & Medicaid Services (CMS) and goes to full service teaching hospitals that serve primarily adult patients. Freestanding children’s hospitals receive little to no GME funding from Medicare because children’s hospitals have a low Medicare caseload. The CHGME Payment Program is administered by the Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS).

Program Goals

To achieve this purpose in a timely and effective manner, the CHGME Payment Program provides support to freestanding children’s teaching hospitals by providing a payment established by a formula in accordance with 42 U.S.C. § 256e.

Program Objective

This program supports the education and training of future pediatricians, pediatric sub-specialists, and other non-pediatric residents in freestanding children’s teaching hospitals, including the training of residents in dentistry and psychiatry. In FY 2021, the CHGME Payment Program distributed approximately $330 million to 59 eligible awardees; in which funding assists these hospitals to care for low-income children across the country.

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.

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2. Background

This program is authorized by 42 U.S.C. § 256e. In 1999, Congress addressed the difference of explicit GME funding between freestanding children’s teaching hospitals and other teaching hospitals by passing the Healthcare Research and Quality Act, which established the CHGME Payment Program. There have been several amendments to the program’s statutory authority, including in April 2014 where the eligibility of the program was expanded to include certain hospitals (see Section III.

Eligibility Information) and most recently in September 2018, amended by the Dr. Benjy Frances Brooks Children's Hospital GME Support Reauthorization Act of 2018 (P.L.

115-241).

The CHGME Payment Program supports HRSA’s mission to improve health outcomes and address health disparities through access to quality services, a skilled health workforce, and innovative, high-value programs. HRSA improves the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. HRSA oversees several grant programs that support the placement of providers, provide financial support to students in health professions programs, provide continuing education to current health professionals, and foster the development of curricula that promote quality health care.

The CHGME Payment Program is designed to support freestanding children’s teaching hospitals by:

• Educating and training future pediatricians, pediatric sub-specialists, and other non-pediatric residents,

• Providing care for vulnerable and underserved children, and

• Conducting innovative and valuable pediatric research.

Funding children’s hospitals is a part of supporting HRSA’s strategic plan to: 1) improve access to quality health care and services; and 2) foster a health care workforce able to address current and emerging needs.

The nearly 60 freestanding CHGME funded children’s teaching hospitals across the country support 51 percent of all pediatric residents and 50 percent of pediatric specialists training in the United States (U.S.) annually, and provide valuable training for physicians in many other specialties.1 These are the physicians who care for America’s youngest population – its children. In Academic Year 2020-2021 CHGME funded over

1 U.S. Department of Health and Human Services, Health Resources and Services Administration, “HRSA Health Workforce: Children’s Hospital Graduate Medical Education Program, Academic Year 2020-2021, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/funding/chgme-accomplishments-2020- 2021.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/funding/chgme-accomplishments-2020-2021.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/funding/chgme-accomplishments-2020-2021.pdf

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13,000 physician and dental residents and fellows.2 The program supported the training of 5,628 Pediatric residents and 2,904 Pediatric medical subspecialty fellows, including training 198 Child and Adolescent Psychiatry fellows. Moreover, CHGME funding supported the training of 4,572 Adult Medical and Surgical Specialty Residents who rotate through children’s hospitals for their pediatrics training. There were also 430 CHGME-funded Advanced General Dentistry residents, including 340 Pediatric Dentistry and 21 Pediatric Orthodontist residents. CHGME-funded hospitals reported having 1,538 patient safety initiatives and programs, with their medical residents and fellows providing over 5.5 million hours of patient care in medically underserved communities.

The CHGME Payment Program statute allows the Secretary of HHS to establish a Quality Bonus System (QBS), whereby the Secretary distributes bonus payments to hospitals participating in the program that meet standards specified by the Secretary.

The goal of the QBS is to recognize CHGME Payment Program awardees that provide high quality training and to incentivize the participating children’s hospitals to meet the pediatric workforce needs of the nation.

In fiscal year (FY) 2017, HRSA began engaging stakeholders in efforts to develop the CHGME QBS. In FY 2018, HRSA released a Federal Register Notice (FRN) seeking public comment on the proposed CHGME QBS and addressed comments received in a later released FRN. Target outcomes included highlighting children’s hospitals' initiatives that have the greatest impact on patient access and quality and those that involve the most residents and/or involve the highest level of resident engagement.

HRSA awarded a QBS evaluation contract in FY 2019 to conduct an environmental scan of GME quality measures, develop quality measures for GME programs in the identified priority areas, and manage an organized stakeholder engagement process on the final QBS standards and measures. Recommendations from the QBS contract and data collected help support HRSA’s plan to implement quality measures in FY 2023, should funds become available for this purpose. See Notice of Funding Opportunity (NOFO) Section V.3 Quality Bonus System for more information.

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the HRSA Health Workforce Glossary

II. Award Information

2 Ibid.

https://www.govinfo.gov/content/pkg/FR-2017-10-16/pdf/2017-22381.pdf https://www.govinfo.gov/content/pkg/FR-2018-06-26/pdf/2018-13592.pdf https://bhw.hrsa.gov/grants/resourcecenter/glossary

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1. Type of Application and Award

Types of applications sought: New and Competing Continuation.

HRSA will provide funding in the form of a grant award formula-based payment program. The amount of funding awarded to each recipient will be determined according to a formula in accordance with 42 U.S.C. § 256e and implementing Federal Register notices. The funds available for the CHGME Payment Program are distributed among participating eligible children’s hospitals. Hospitals that meet eligibility requirements in Section III.1 receive funds based on the annual appropriation.

The CHGME Payment Program makes payments throughout the year to distribute the Direct Medical Education (DME) and Indirect Medical Education (IME) funding. Each of the funding amounts is determined by a formula, and a hospital receives its proportion of the total CHGME Payment Program funding based on the calculation of the formula.

The formula was established by CHGME policy published in the June 19, 2000 Federal Register notice and the July 20, 2001 Federal Register notice. For DME, the CHGME Payment Program funding is proportional to the number of residents the hospital trains.

Furthermore, the DME payment formula accounts for a hospital’s specific geographic variations in costs, and inflation. For IME, the CHGME formula takes into account the severity of illness of its inpatients, the number of inpatient discharges, the number of available beds, and the number of residents the hospital trains.

2. Summary of Funding

HRSA estimates approximately $332,000,000 to be available annually to fund up to 62 recipients; this includes an estimated amount of up to $3 million for the CHGME QBS.

The actual amount of CHGME Payment Program funding available, if any, will not be determined until the enactment of the final FY 2023 federal appropriation. This NOFO 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 October 1, 2022 through September 30, 2023 (one year).

In April 2014, the CHGME Payment Program was reauthorized to expand eligibility to “Newly Qualified Hospitals” that meet the eligibility requirements in Section III.1.b. The reauthorization permits the Secretary, “to make available up to 25 percent of the total amounts in excess of $245,000,000 …but not to exceed $7,000,000” 3 for the purpose of making CHGME Payment Program payments to these Newly Qualified Hospitals and for the QBS.

In FY 2022, Congress appropriated $375 million to the CHGME Payment Program. Of this amount, up to $4 million in payments are targeted to these newly qualified hospitals.

3 42 U.S.C. § 256e(h)(1), https://www.govinfo.gov/app/details/USCODE-2010-title42/USCODE-2010-title42-chap6A-subchapII-partD-subpartix-sec256e https://www.govinfo.gov/content/pkg/FR-2000-06-19/pdf/00-15332.pdf https://www.govinfo.gov/content/pkg/FR-2000-06-19/pdf/00-15332.pdf https://www.federalregister.gov/documents/2001/07/20/01-18166/childrens-hospitals-graduate-medical-education-chgme-payment-program-final-methodology-for

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If funding levels and mechanisms remain constant, it is estimated that up to approximately $3 million may be available in FY 2023 for the CHGME QBS. If the total amount available for the CHGME QBS in FY 2023 is less than $2 million, HRSA does not plan to implement the CHGME QBS in FY 2023 to minimize the administrative burden on the hospitals. In this case, the funds will be disbursed to all eligible hospitals (including those newly qualified) according to the CHGME Payment Program formula payment methodology.

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

There are two categories of children’s hospitals that may be eligible for CHGME payments in FY 2023, depending on the funding appropriated to the program – “Currently Eligible Hospitals” and “Newly Qualified Hospitals.” Hospitals that are applying for the first time for the CHGME Payment Program may be hospitals that are new to the CHGME Payment Program but qualify under the “Currently Eligible Hospitals” requirements or are eligible as a “Newly Qualified Hospital.”

a. Currently Eligible Hospitals: Includes freestanding children’s hospitals that meet the original eligibility requirements for CHGME payments that were established prior to the Children’s Hospital GME Support Reauthorization Act of 2013. These freestanding children’s hospitals must meet the following criteria:

1) Have a Medicare provider agreement;

2) Are excluded from the Medicare Inpatient Prospective Payment System (IPPS) pursuant to section 1886(d)(1)(B)(iii) 4 of the Social Security Act (SSA) and its accompanying regulations; and

3) Participate in an approved GME residency training program as defined in section 1886(h)(5)(A) of the SSA.

b. Newly Qualified Hospitals: As per the Children’s Hospital GME Support Reauthorization Act of 2013, a freestanding hospital may be eligible for CHGME

4 The exclusion of children’s hospitals from IPPS set forth under section 1886(d)(1)(B)(iii) of the SSA states this exclusion exists for hospitals “whose inpatients are predominantly individuals under 18 years of age”.

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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payments depending on the level of funding appropriated to the program if it meets the following criteria:

1) Has a Medicare provider agreement;

2) Is excluded from Medicare IPPS pursuant to section 1886(d)(1)(B) of the SSA and its accompanying regulations;

3) Its inpatients are predominantly individuals under 18 years of age;

4) Has an approved medical residency training program as defined in section 1886(h)(5)(A) of the SSA; and

5) Is not otherwise qualified to receive payments as a Currently Eligible Hospital as defined by section 1886(h) of the SSA.

For those freestanding children’s hospitals that met the above requirements for Newly Qualified Hospitals as of April 7, 2014, and the Secretary had not previously determined an average number of FTE residents under section 1886(h)(4) of the SSA, the Secretary may establish such number of FTE residents for the purposes of calculating CHGME Payment Program payments.

Any public or private nonprofit and for-profit children's teaching hospital with an accredited residency training program (as defined below), that meets all of the above requirements for either category of eligibility may apply, though final eligibility for receiving funds as a “currently eligible hospital” or as a “newly qualified hospital” will depend on appropriated funding levels. Children’s hospitals applying for the CHGME Payment Program must train residents during the fiscal year for which they apply for funds.

Residents may be included in a hospital’s FTE resident count for CHGME Payment Program purposes if the residency program (in which the resident is enrolled) meets one of the following criteria:

1. The program must lead toward board certification of its graduates by the American Board of Medical Specialties (ABMS) and also be approved for education and training activities by one of the following accrediting bodies:

• Accreditation Council for Graduate Medical Education

• American Osteopathic Association

• Commission on Dental Accreditation of the American Dental Association

• Council of Podiatric Medicine Education of the American Podiatric Medical Association

2. The program may count towards certification of the resident in a specialty or subspecialty listed in the current edition (at the time of the audit review) of the Directory

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of Graduate Medical Education Programs (published by the American Medical Association) or the Annual Report and Reference Handbook (published by the American Board of Medical Specialties).

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Payments will be determined in compliance with all program mandates, rules, regulations, policies, and guidance.

Deadline HRSA may not consider an application for funding if it fails to satisfy the deadline requirements referenced in Section IV.4.

Multiple Applications Multiple applications from an organization are not allowable. If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, 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. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

Hospitals that qualified to receive CHGME funds as “Newly Qualified Hospitals” under the Children’s Hospital GME Support Reauthorization Act of 2013, as of April 7, 2014, and that do not already have a CMS cap established and are not able to apply for a CMS cap as a new residency training program, will have a “CHGME cap” established.

The “CHGME cap” will be established using the number of FTE residents trained during the most recent Medicare cost report period completed on or before April 7, 2014. This value will be entered on sections 4, 5, and 6, of the HRSA 99-1, on lines 4.06, 5.06, and

6.06 as applicable. The “CHGME cap” reported by newly qualified hospitals will be verified by the CHGME auditors during the FY 2023 audit process.

Hospitals are responsible for the accuracy of application data submitted to HRSA and are subject to an audit. Hospitals are not required to submit documentation with their initial application to support resident counts reported on their CHGME Payment Program application. However, hospitals should be prepared to produce documentation in accordance with 42 CFR § 413.75(d) in any subsequent audit carried out by HHS or

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its delegate. The CHGME Payment Program has in place a FTE Resident Assessment (audit) process in place. Auditors conduct an assessment of the FTE resident counts each fiscal year between October and March. The results of these FTE resident assessments are the basis for the hospitals’ reconciliation applications. The audit methodology complies with the requirements under 42 CFR § 413.75(d) and parallels a similar GME audit process carried out by CMS to adjudicate the number of residents training in teaching hospitals that treat primarily adult patients. Children’s hospitals that do not report FTE resident counts to Medicare are not exempt from this policy. An official of the hospital must verify the information provided in the application used to support the number of FTE residents for a particular cost-reporting period.

The audit is conducted to verify that the FTE resident counts reported by the participating children’s hospitals are accurate; and to identify the FTE residents claimed for CHGME payment during the same period of training time claimed for reimbursement from any other source of federal GME funding, to include GME programs within HRSA (e.g. THCGME Program), CMS, and the Department of Defense. If a FTE resident’s time is reported to any other federal GME programs for the purposes of receiving payment, the children’s hospitals cannot also claim that same time for payment from the CHGME Payment Program. It is the responsibility of the children’s hospital to resolve any overlaps (i.e., two or more hospitals claim a resident for the same or an overlapping period of time) before a disputed FTE resident will be included in the final FTE resident count used for calculation of CHGME Payment Program funding.

HRSA requires applicants to coordinate with affiliated teaching hospitals and teaching health centers in order to avoid over-reporting of CHGME- supported FTE residents.

The FTE Resident Assessment audit contractor will review the institutional agreement (also known as an affiliation agreement, memorandum of understanding, inter-institutional agreement, letter of commitment, letter of affiliation, letter of agreement, or written agreement) between a children’s hospital and the sponsoring institution/residency program if the children’s hospital is not the sponsoring institution or a major participating institution.

The institutional agreement is to identify the name(s) of the sponsoring institution(s), the residency program in which the residents are enrolled, the children’s hospital, the residency program or department at the children’s hospital where the residents will be rotating, the number of FTE residents allowed (e.g. 1 FTE per month), effective and expiration dates of the agreement, and financial arrangements. Agreements may vary slightly by specialty due to varying accrediting body residency review committee requirements for institutional agreements.

IV. Application and Submission Information

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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) Two-Tier workspace application package associated with this notice of funding opportunity (NOFO), following the directions provided at Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov: APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA 23-012 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.

A budget information is NOT required for this funding opportunity. In conjunction with the application requirements and instructions in Section 5 of HRSA’s SF-424 R&R Two- Tier Application Guide, please note the following:

Initial Application Process Overview Phase 1. Grants.gov application: Required information must be complete and successfully validated under the correct funding opportunity number by 11:59 P.M. Eastern Time (ET) on August 1, 2022.

Phase 1 Steps:

Step 1: Confirmation of current registration with the System for Award Management (SAM.gov)

Step 2: Registration & Finding the CHGME NOFO on Grants.gov

Step 3: Completion of the SF-424 (R&R) short form in Grants.gov

The following should be included as part of the Grants.gov submission:

a) SF-424 R&R cover page;

b) Project/Performance Site Location(s) form;

c) Project Abstract (required); and

d) Disclosure of Lobbying Activities (SF-LLL), if applicable.

Only applicants who have successfully submitted a validated application in Grants.Gov (i.e., have completed Phase 1) by the August 1, 2022 deadline due date may submit the additional information on the CHGME Payment Program data forms in the HRSA EHBs (in order to complete Phase 2).

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf

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A project abstract is REQUIRED to be submitted in Phase 1 to consider an application complete. The project abstract is a new requirement for the CHGME Payment Program and should accurately describe your organization’s objectives and goals within the context of a summary of the project. As an applicant, please seek guidance from your organization’s Designated Institutional Official (DIO) to complete the project abstract form. Starting April 4, 2022, the UEI (SAM) will be the unique entity identifier for federal funding opportunities.

Phase 2. HRSA EHBs: Registration and CHGME applications must be completed and successfully submitted and validated by 5:00 P.M. Eastern Time on September 1, 2022, by your organization’s designated Authorizing Official that has been designated to the CHGME Payment Program.

Please note that you can only begin Phase 2 in the HRSA EHBs after Phase 1 in Grants.gov has been completed by the application due date and HRSA has assigned a tracking number to the application a tracking number. A complete CHGME application includes the submission of supplemental information, which are completed data forms HRSA- 99, HRSA 99-1 (1 through 4), HRSA 99-2, and HRSA 99-5, as well as the required Attachments as identified in this NOFO.

Phase 2 Steps:

Step 1: Registration in HRSA Electronic Handbooks (EHBs)

Step 2: Access, complete, and submit of CHGME application in HRSA EHBs

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2. Content and Form of Application Submission

Unless indicated otherwise in this NOFO, you must submit the information outlined in the SF-424 R&R Two-Tier Application Guide in addition to the program specific information below. You should not attach any supporting documentation that contains personal identifying information with the application including rotation schedules, IRIS data, etc. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Two-Tier Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and must be in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 9.5 of the SF-424 R&R Two-Tier Application Guide for the Application Completeness Checklist. Applications must be complete and validated by Grants.gov under the correct funding opportunity number prior to the Phase 1 deadline, and supplemental information must be submitted in the EHBs prior to the Phase 2 deadline, to be considered under this notice. See Section 5 of the HRSA SF-424 R&R Two-Tier Application Guide for Instructions for Completing the SF-424 R&R for Two-Tier Application.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment #5: Other Relevant Documents.

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

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Two-Tier Application Guide include the following:

i. Program-Specific Forms

The CHGME application includes four (4) forms that are available electronically in the EHBs:

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf 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 https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf

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a) HRSA 99: Demographic and Contact Information Form

b) HRSA 99-1: Determination of Weighted and Unweighted Resident FTE Count Form

c) HRSA 99-2: Determination of Indirect Medical Education Data Related to the Teaching of Residents Form

d) HRSA 99-5: Application Checklist

Copies of these forms are included in the NOFO for your reference (Appendix A). Do not include these tables as part of the Grants.gov application submission since you will be entering the data online in the HRSA EHBs by accessing the CHGME web application as part of Phase 2.

ii. 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 within the EHBs. Any hyperlinked attachments will not be reviewed/opened by HRSA.

Please provide the following items to complete the content of the application. Each attachment must be clearly labeled, and is to be submitted during Phase 2 of the application directly in the EHBs.

Attachment 1 – If the hospital files a full Medicare Cost Report with CMS, attach Worksheet E-3 part IV or Worksheet E-4 of the Medicare Cost Reports for each of the Medicare Cost Report periods (where applicable).

Attachment 2 – Medicare Affiliation agreements when the hospital utilizes such agreements to increase/decrease its 1996 FTE resident cap, including a letter indicating that the affiliation agreements were filed with CMS prior to July 1 of that affiliation agreement’s academic year.

Attachment 3 – Documents providing support of additions or reductions to FTE resident cap, if applicable.

Attachment 4 – Evidence of non-profit status, if applicable.

Attachment 5 – Delinquency on federal debt explanation and/or Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification explanation, if applicable.

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3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

The UEI, a “new, non-proprietary identifier” assigned by the System for Award Management (SAM.gov), has replaced the UEI Data Universal Numbering System (DUNS) number.

Effective April 4, 2022:

• You will no longer use a DUNS number and that number will not be maintained in any Integrated Award Environment (IAE) systems (SAM.gov, CPARS, FAPIIS, eSRS, FSRS, FPDS-NG). For more details, visit the following webpages:

Planned UEI Updates in Grant Application Forms and General Service Administration’s UEI Update.

You must register with SAM and continue to maintain active SAM registration with current information at all times when you have an active federal award; an active application, or an active plan under consideration by an agency (unless you are an individual or federal agency that is exempted from those requirements under 2 CFR § 25.110(b) or (c), or you have an exception approved by the agency under 2 CFR § 25.110(d)). For your SAM.gov registration, you must submit a notarized letter appointing the authorized Entity Administrator.

If you are chosen as a recipient, HRSA will not make an award until you have complied with all applicable SAM requirements. If you have not fully complied with the requirements by the time HRSA is ready to make an award, you may be deemed not qualified to receive an award, and HRSA may use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another federal agency, confirm that the registration is still active and that the Authorized Organization Representative (AOR) has been approved.

The Grants.gov registration process requires information in two separate systems:

• SAM (https://sam.gov/content/home | SAM.gov Knowledge Base)

• Grants.gov (https://www.grants.gov/)

For more details, see Section 3.1 of HRSA’s SF-424 R&R Two-Tier Application Guide.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf

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4. Submission Dates and Times

Application Due Date The application due dates under this NOFO is are

• Phase 1: Grants.gov: August 1, 2022 at 11:59 p.m. ET.

• Phase 2: HRSA EHBs: September 1, 2022 at 5:00 p.m. ET.

Only applicants who successfully have successfully submitted an application validated in Grants.Gov (Phase 1) by the August 1, 2022 due date may submit the additional information CHGME Payment Program data forms in the HRSA EHBs (Phase 2). A project abstract is REQUIRED to be submitted.

HRSA suggests submitting applications to Grants.gov at least 3 calendar days before the deadline to allow for any unforeseen circumstances. See Section 8.2.5 – Summary of emails from Grants.gov of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

5. Intergovernmental Review

Children’s Hospitals Graduate Medical Education Payment Program is not subject to the provisions of Executive Order 12372, as implemented by 45 CFR part 100.

See Section 4.1 ii of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

6. Funding Restrictions

You may request funding for a period of performance of up to one year. This program NOFO 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.

It is anticipated that funds awarded under this payment program will be for direct and indirect graduate medical expenses. Funding is dependent on the availability of funds and the amount of funding will be determined based on congressionally appropriated dollars.

Funds under this notice may not be used for purposes specified in HRSA’s SF-424 R&R Two-Tier Application Guide under “Funding Restrictions.”

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide-2-tier.pdf

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The General Provisions in Division H of the Consolidated Appropriations Act, 2022 (P.L.

117-103) apply to this program. Please see Section 5.1.iv of HRSA’s SF-424 R&R Two- Tier Application Guide for additional information. Note that these or other restrictions may apply in following fiscal years, as required by law.

You are required to have the necessary policies, procedures, and financial controls in place to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on use of funds for lobbying, executive salaries, gun control, abortion, etc. Like all other applicable CHGME Payment Program award requirements, the effectiveness of these policies, procedures, and controls is subject to audit.

Be aware of the requirements for HRSA recipients and subrecipients at 2 CFR §

200.216 regarding prohibition on certain telecommunications and video surveillance services or equipment. For details, see the HRSA Grants Policy Bulletin Number: 2021- 01E.

V. Application Review Information

1. Review Criteria

The Children’s Hospitals Graduate Medical Education (CHGME) Payment Program is a formula-based payment program. HRSA has procedures for assessing the technical merit of applications and to assist you in understanding the standards against which your application will be reviewed. HRSA will review each application for completeness and eligibility, and compliance with the requirements outlined in this NOFO. The CHGME Payment Program funds are distributed among eligible entities as formula-payment based payments awards according to data supplied in your application. HRSA will calculate FY 2023 award amounts based on the application data submitted in the initial application and reconciliation application.

Application review is conducted at HRSA by HRSA staff, and Fiscal Intermediaries (FI) conduct an independent assessment of FTE resident count. Section 340E(e)(3) of the Public Health Service Act states, in part, “[t]he Secretary shall determine any changes to the number of residents reported by a hospital in the application of the hospital for the current fiscal year to determine the final amount payable to the hospital for the current fiscal year for both direct expense and indirect expense amounts.” The assessment of the FTE resident count by FIs occurs within a six-month period from the start of the federal fiscal year to the spring of the same federal fiscal year, to allow for reconciliation of payments within the appropriation year for which payments are made. CHGME FIs carry out the FTE assessment of residents each fiscal year, and each of the children’s hospitals participating in the program is subject to this assessment. The final amount https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf

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determined through the reconciliation process is subject to administrative and judicial review under section 1878 of the SSA.

2. Review and Selection Process

The funds appropriated for the CHGME Payment Program are distributed among participating institutions as a formula-based payment program. Program data reported on HRSA forms are used to determine funding and administer the program. All required tables must be submitted electronically in the HRSA EHBs with the Phase 2 submission. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

3. Quality Bonus System (QBS) Payment

The FY 2023 CHGME NOFO includes up to an estimated $3 million that may be available for the CHGME QBS, which focuses on quality measurement and improvement. The goals of the QBS further are to recognize hospitals for quality improvement and GME transformation efforts in high priority focus areas and build standards to increase engagement and involvement of residents in broader initiatives involving high priority focus areas. which supports HRSA’s efforts to improve the quality of the data collected about our programs, which will in turn assist in measuring and demonstrating long-term programmatic impacts and effectiveness.

In order to qualify for the QBS payment,

1. CHGME awardees must complete individual level documentation for all residents supported by the CHGME Payment Program in the FY 2023 Annual Performance Report (AY 2022-2023); and

2. CHGME awardees must report at 90% or greater response rate, excluding the “Not Reported” response option, in any individual level demographic including ethnicity, race, rural background and disadvantaged background, and training level data including training in telehealth and interprofessional teams in the FY 2023 Annual Performance Report (AY 2022-2023); and

3. Awardees must provide 50% or greater complete post-residency employment data in the FY 2023 Annual Performance Report (AY 2022- 2023).

See CHGME Annual Performance Report (AY 2021–2022) Instruction Manual for further information about the required performance measures collected.

Payment Structure: QBS payments in FY 2023 are targeted to be disbursed at the end of the fiscal year to ensure CHGME follows legislative mandates. CHGME hospitals that submit the required documentation outlined above will receive a portion of the available funds for the CHGME QBS payment. Amounts will be distributed according to a three tiered payment structure that recognizes the different annual payment levels received by CHGME hospitals. A QBS base payment rate will be determined from the total https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualhtmL.aspx?FormCode=1&IsPM=True&EHBActivityCode=T23

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amount available and the number of hospitals that qualify for the CHGME QBS in a fiscal year. Hospitals that meet the QBS standards will be divided into three tiers based on their combined direct and indirect fiscal year payment amounts, as calculated per the established CHGME Payment Program formulas:

Tier 1: Hospitals that qualify for the quality bonus payment that are in the lowest third of calculated CHGME annual payments among hospitals that qualify for the quality bonus payment will receive the QBS base payment.

Tier 2: Hospitals that qualify for the quality bonus payment that are in the middle third of calculated CHGME annual payments among hospitals that qualify for the quality bonus payment will receive two times the QBS base payment.

Tier 3: Hospitals that qualify for the quality bonus payment that are in the highest third of calculated CHGME annual payments among hospitals that qualify for the quality bonus payment will receive three times the QBS base payment.

4. Assessment of Risk

HRSA may elect not to fund applicants with management or financial instability that directly relates to the organization’s ability to implement statutory, regulatory, or other requirements (45 CFR § 75.205).

HRSA reviews applications receiving a favorable objective review for other considerations that include past performance, as applicable; cost analysis of the project/program budget; assessment of your management systems, ensuring continued applicant eligibility; and compliance with any public policy requirements, including those requiring just-in-time submissions. HRSA may ask you to submit additional programmatic or administrative information (such as an updated budget or “other support” information) or to undertake certain activities (such as negotiation of an indirect cost rate) in anticipation of an award. However, even at this point in the process, such requests do not guarantee that HRSA will make an award. Following review of all applicable information, HRSA’s approving and business management officials will determine whether HRSA can make an award, if special conditions are required, and what level of funding is appropriate.

Award decisions are discretionary and are not subject to appeal to any HRSA or HHS official or board.

HRSA is required to review and consider any information about your organization that is in the Federal Awardee Performance and Integrity Information System (FAPIIS). You may review and comment on any information about your organization that a federal awarding agency previously entered. HRSA will consider your comments, in addition to other information in FAPIIS in making a judgment about your organization’s integrity, business ethics, and record of performance under federal awards when completing the https://www.fapiis.gov/ https://www.fapiis.gov/

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review of risk as described in 45 CFR § 75.205 HHS Awarding Agency Review of Risk Posed by Applicants.

HRSA will report to FAPIIS a determination that an applicant is not qualified (45 CFR § 75.212).

VI. Award Administration Information

1. Award Notices

HRSA will intends to release the Notice of Award (NOA) on or around the start date of October 1, 2022, subject to availability of funds. See Section 5.4 of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

HRSA intends to issue the Notice of Award (NOA) to “Currently Eligible Hospitals”, subject to the availability of funds, through following the enactment of an annual appropriation or a continuing resolution. HRSA intends to issue the Notice of Award (NOA) in accordance with CHGME Payment Program legislation, to “Newly Qualified Hospitals” only if an annual appropriation is passed and only if the annual appropriation is funded at $245,000,000 or more for FY 2023 in accordance with 42 U.S.C. § 256e(h).

See Section 6.4 of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

For “Newly Qualified Hospitals,” the reauthorization permits the Secretary, “to make available up to 25 percent of the total amounts in excess of $245,000,000” but “not to exceed $7,000,000.” “Newly Qualified Hospitals” will not receive an award, if any, until after an annual appropriation has been passed, and only if the annual appropriation is funded at $245,000,000 or more for FY 2023.

2. Administrative and National Policy Requirements

See Section 2.1 of HRSA’s SF-424 R&R Two-Tier Application Guide.

If you are successful and receive a NOA, in accepting the award, you agree that the award and any activities thereunder are subject to:

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-C/section-75.205…