BHW HRSA-23-013 (T9C) THCGME Final.pdf

U.S. Department of Health and Human Services

Fiscal Year 2023

Bureau of Health Workforce

Division of Medicine and Dentistry

Teaching Health Center Graduate Medical Education (THCGME) Program

Funding Opportunity Number: HRSA-23-013

Funding Opportunity Type(s): New

Assistance Listings Number: 93.530

Application Due Date: October 18, 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: August 19, 2022

Kristin Gordon Project Officer, Division of Medicine and Dentistry Telephone: (301) 443-0337 Email: KGordon@hrsa.gov See Section VII for a complete list of agency contacts.

Authority: Section 340H of the Public Health Service (PHS) Act [42 U.S.C. 256h];

Title II, Subtitle G, Section 2604 of the American Rescue Plan Act of 2021 (P.L. 117-2).

mailto:KGordon@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 above or in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Teaching Health Center Graduate Medical Education (THCGME) Program. The THCGME Program provides funding to support the training of residents in primary care residency training programs in community-based ambulatory patient care centers. Payments will be made for the following: (1) expansion awards to support an increased number of resident Full-Time Equivalent (FTE) positions at existing HRSA THCGME Programs, and (2) new awards to support new resident FTE positions at new Teaching Health Centers (THCs). New THCs are applicants that have never received payment under the HRSA THCGME Program for the applicable residency program.

Funding Opportunity Title: Teaching Health Center Graduate Medical Education (THCGME) Program

Funding Opportunity Number: HRSA-23-013

Due Date for Applications: October 18, 2022

Anticipated FY 2023 Total Annual Available Funding:

$18,400,000

Estimated Number and Type of Award(s): Approximately 28 awards

Estimated Annual Award Amount:

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

Cost Sharing/Match Required: No

Period of Performance:

July 1, 2023 through June 30, 2027

(Four (4) years) https://www.hrsa.gov/

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

• Family Medicine

• Internal Medicine

• Pediatrics

• Internal Medicine-Pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 R&R Application Guide.

Visit HRSA’s How to Prepare Your Application page for more information.

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 to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application 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

3. COST SHARING/MATCHING

4. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract – All Applicants

ii. Project Narrative – All Applicants

iii. Budget

iv. Resident FTE Request Justification Narrative – All Applicants

v. Standardized Work Plan (SWP) Form

vi. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: ASSURANCES DOCUMENT

APPENDIX B: ELIGIBLE RESIDENT/FELLOW FTE CHART

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I. Program Funding Opportunity Description

1. Purpose

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

Program Purpose

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

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

1. Expansion awards for an increaseed number of resident Full-Time Equivalent (FTE) positions at existing HRSA THCGME Programs.

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

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

Program Goals

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

Program Objectives

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

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

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

1. Expansion (new applications) – Existing HRSA THCGME residency program recipients may request expansion of resident FTEs above the baseline, which, for the purposes of this NOFO, is the number of resident FTEs trained by the program in Academic Year (AY) 2018-2019. Such expansion requests can only be made for resident FTEs currently not otherwise funded by HRSA if the requested resident FTEs are not supported by another federal or state funding source by the project period start date (July 1, 2023). Training of newly supported THCGME residents must start in

AY 2023-2024.

Existing THCGME Residency Programs that wish to request support for an expanded number of resident FTEs beyond the number stated in their most recent HRSA THCGME Program Resident FTE Approval Letter must submit an application for the expanded number of resident FTEs.

2. New THCs (new applications) – New residency program applicants must demonstrate the need for the number of resident FTE(s) being requested and that the number of resident FTEs being requested is above the program’s baseline. The baseline is the number of resident FTEs trained by the program in AY 2018-2019. New applicants may request THCGME support for resident FTEs if the requested resident FTEs are not supported by another federal, state, non-profit or for-profit funding source by the project period start date (July 1, 2023). Training of newly supported THCGME residents must start in AY 2023-2024.

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

Expansion and New THC applicants that are currently training residents may request resident FTEs for THCGME support; however, all resident FTEs for whom THCGME support is requested must be above the program’s resident FTE baseline, as documented in your Eligible Resident/Fellow FTE Chart (Attachment 4) and must not put the program above the number approved by, or awaiting approval by, the relevant accrediting body, as documented in Attachment 5.

Funds from a THCGME award may not be used to replace or supplant funds that have been provided from a different source (e.g., any federal, state, local, tribal, non-profit or for-profit entity) for the same resident FTEs.federal. Such replacement or supplanting may be grounds for suspension or termination of current and future federal awards, recovery of

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misused federal funds, and/or other remedies available by law. Applicants must provide documentation in Attachment 9 that assures the resident FTEs will not be supported or would not otherwise be supported through an alternate source.

For more details, see Program Requirements and Expectations.

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, resident FTE training.

2. Background

The THCGME Program is authorized by Section 340H of the PHS Act [42 U.S.C. 256h].

The National Center for Health Workforce Analysis (NCHWA) projects that the total demand for primary care physicians will grow by 15,210 FTEs between 2018 and 2030.1 By 2030, NCHWA projects the following changes to the supply and demand of primary care service providers:

• Family physicians – 6% increase in supply, 13% increase in demand

• General internal physicians – 13% increase in supply, 22% increase in demand

• Geriatric physicians – 8% decrease in supply, 50% increase in demand

• Pediatric physicians – 2% increase in supply, 5% increase in demand2

The NCHWA also notes that the national demand for dentists is projected to grow by 206,850 FTEs in 2030—a 9 percent increase. While estimates suggest the U.S. could have an adequate supply of dentists as an entire occupation to meet projected growth in demand for oral health services in 2030 under the status quo scenario (which assumes current oral health care use and delivery patterns for dental services remain the same in 2030 as they are in 2017), the demand for general dentists is predicted to exceed supply by 2030.3 In addition to overall shortages, there is maldistribution of primary care

1 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA. Workforce Projection Dashboard. Available at: https://data.hrsa.gov/topics/health-workforce/workforce-projections. Accessed June 2022.

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA. “Primary Care Workforce Projections”. September 2021. Available at: https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/primary-health.

3 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA. “Oral Health Workforce Projections, 2017-2030: Dentists and Dental Hygienists”. Available at:

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/oral-health-2017-2030.pdf.

https://data.hrsa.gov/topics/health-workforce/workforce-projections https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/primary-health https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/primary-health https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/oral-health-2017-2030.pdf

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physicians and dentists with rural and other underserved communities experiencing the greatest shortages.

The THCGME Program was authorized in response to the nation’s growing need for primary care services and as a new model for GME focused on primary care physician and dentist training in ambulatory care settings. The Medicare Payment Advisory Commission (MedPAC) and other stakeholders have called for increasing the amount of GME time spent in nonhospital settings, making changes to GME funding to advance goals such as increasing community-based care, and increasing the diversity of the pipeline of health professionals.4

The THCGME Program aims to strengthen the primary care workforce by supporting medical and dental training programs in primary care, community-based settings with an emphasis on improving the distribution of this health workforce in rural and underserved communities. The program focuses on a different model for resident education than most other federally funded models of GME, which are predominantly located in large, urban academic medical centers. This model was developed based on evidence showing that family medicine resident physicians who train in health center settings are nearly three times as likely to practice in underserved settings after graduation when compared to residents who did not train in health centers.5 There is also evidence that physicians who receive training in community and underserved settings are more likely to practice in similar settings, such as health centers.6,7

The THCGME Program is providing a vital supply line to support the primary care health workforce demand. Since the program began in FY 2010, the THCGME Program has graduated 1,731 new primary care physicians and dentists who have entered the workforce. THCGME residents have provided over 4.2 million hours of patient care in primary care settings during 3.6 million patient encounters. Residents additionally provided over 6.7 million hours of patient care in medically underserved and rural settings, significantly expanding access to care in these key settings.8

While the national average for physicians going into primary care is approximately 33 percent, the THCGME Program has evidenced much stronger results. Cumulative follow-up data indicates that 65 percent of THCGME-funded graduates are currently practicing in a primary care setting and approximately 56 percent of the THCGME-funded graduating

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

(Available at; https://www.medpac.gov/document/medpac-june-2010-report-to-the-congress/ 5 Morris CG, Johnson B, Kim S, and Chen FM. Training Family Physicians in Community Health Centers: A Health Workforce Solution. Family Medicine. 2008; 40(4):271-6.

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

7 Goodfellow A, Ulloa J, Dowling P, et al. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Academic Medicine. 2016; 91(9): 1313– 1321.

8 Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. THCGME Program Academic Year 2020-2021 Highlights. Available at:

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/thcgme-outcomes-2020-2021.pdf.

https://www.medpac.gov/document/medpac-june-2010-report-to-the-congress/ https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/thcgme-outcomes-2020-2021.pdf

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physicians and dentists are currently practicing in a medically underserved community and/or rural setting. In AY 2020-2021, nearly all THCGME-funded residents (98 percent) received training in a primary care setting, providing care during almost half a million patient encounters and accruing over 600,000 contact hours with these primary care patients. Additionally, the majority of THCGME-funded residents (93 percent) spent a significant part of their training in medically underserved and/or rural communities, providing over 1.1 million contact hours of patient care.

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 THCGME Program for Fiscal Year 2023:

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

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

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

GME consortium means a collaboration between a community-based, ambulatory patient care center and community stakeholders (e.g., academic health centers, universities and/or medical schools, teaching hospitals, and critical access hospitals), to form an entity that serves as the institutional sponsor of, and operates, an accredited primary care residency program. The community-based ambulatory patient care center plays an integral role in the academic, financial, and administrative operations of the residency program, as well as in the academic and clinical aspects of the program including, but not limited to: curriculum development, scheduling of clinical rotations, and selection of staff and residents. The relationship between the THC and the consortium must be legally binding, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

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

https://bhw.hrsa.gov/grants/resourcecenter/glossary

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

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

II. Award Information

1. Type of Application and Award

Type of applications sought: New

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

2. Summary of Funding

HRSA expects approximately $18,400,000 to be available to fund approximately 28 recipients.

The period of performance is July 1, 2023 through June 30, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for the THCGME Program in subsequent fiscal years, satisfactory progress and a decision that continued funding is in the best interest of the Federal Government.

The FY 2023 THCGME Program payment is formula-based and provides a payment inclusive of both DME and IME support. The final payment methodology for the THCGME Program has not yet been established. The FY 2023 interim payment rate will be $160,000 per resident FTE. In subsequent fiscal years, the payment rate may change due to available appropriations and/or changes in payment methodology.

HRSA may reduce or take other enforcement actions regarding recipient funding levels beyond the first year if they are unable to fully succeed in achieving the goals listed in their applications.

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Reconciliation

All THCGME funding is subject to annual reconciliation (see section 340H(f) of the PHS Act [42 U.S.C. 256h(f)]). During reconciliation, any changes to the number of residents reported by the award recipient will be calculated in order to determine a final amount payable for the budget period.

Recipients are responsible for the accuracy of resident FTE data submitted to HRSA and may be audited by HRSA to ensure the accuracy and completeness of the information submitted. In addition, Section 340H(e) of the PHS Act [42 U.S.C. 256h(e)] describes the relationship between THCGME Program funding and GME payments made by Medicare and the Children’s Hospital Graduate Medical Education Payment (CHGME) program. If a resident FTE’s time is submitted to Medicare or the CHGME program for the purposes of receiving payment, the THC cannot also claim that same time for payment from the THCGME Program. HRSA requires applicants to coordinate closely with affiliated teaching hospitals in order to avoid over-reporting of THCGME supported resident FTE positions. Over-reporting of resident FTEs, including ineligible resident FTEs, and subsequent over-payment will result in the recoupment of THCGME payments.

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

III. Eligibility Information

1. Eligible Applicants

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

A. Eligible Entities

An eligible entity is a community-based ambulatory patient care center that:

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

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

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

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

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

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

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

OR

ii. Has formed a GME consortium that operates an accredited primary care residency program.

In order to satisfy accreditation, academic and administrative responsibilities, a community-based ambulatory patient care center may form a GME consortium with stakeholders (e.g., academic health centers, universities and/or medical schools, teaching hospitals, and critical access hospitals) where the GME consortium serves as the institutional sponsor of an accredited primary care residency program. The relationship between the community-based ambulatory patient care center and the consortium must be legally binding, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

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

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

B. Eligible Primary Care Residency Programs

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

• Family Medicine

• Internal Medicine

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• Pediatrics

• Internal Medicine-pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

C. Accreditation/Institutional Sponsorship

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

The applicant must provide documentation that the residency program is accredited.

Accreditation documents must indicate the accrediting body and include the name of the residency program’s institutional sponsor, number of approved resident positions, and the dates of accreditation for verification purposes (see Attachment 5). Applicants that are in the process of obtaining accreditation for their residency program(s) may apply through this announcement but MUST provide documentation from the relevant accrediting body demonstrating that the accreditation process has been initiated prior to the HRSA-23-013 NOFO application due date. Further, applicants will not receive THCGME program funds if documentation of accreditation is not received by HRSA by June 1, 2023. Relevant accreditation application documentation should be included in Attachment 5. Applicant residency programs must be prepared to begin training residents starting July 1, 2023. HRSA intends to issue approval letters to successful applicants in early 2023 in order to allow programs to recruit residents for the 2023- 2024 AY that will begin July 1, 2023.

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

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

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3. Other

HRSA may not consider an application for funding if it contains the non-responsive criteria below:

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

Other funding sources THCGME funds must be used for program activities and may not replace or supplant funds that have been provided from a different source (e.g., a federal, state, local, tribal, non-profit or for-profit entity) for the same resident FTE slot(s). Such replacement or supplanting may be grounds for suspension or termination of current and future federal awards, recovery of misused federal funds, and/or other remedies available by law.

Applicants must provide documentation in Attachment 9 that assures that the resident FTEs will not be supported through an alternate source.

Multiple Applications

NOTE: Multiple applications from an eligible community-based entity or GME consortium with the same DUNS number or Unique Entity Identifier (UEI) are allowable if the applications seek funding for separate and distinct residency programs. Entities seeking THCGME funding to support multiple residency programs MUST submit a separate application for each individual residency program. If an entity is submitting multiple applications for different residency programs, please include a unique name for each training program in the project abstract to differentiate between applications.

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

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.grants.gov/

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Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form, and use the Project Abstract Summary Form 2.0 in workspace to complete the Project Abstract Summary. See Section IV.2.i Project Abstract for content information.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-013 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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

NOFO.

2. Content and Form of Application Submission

Application Format Requirements

Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the 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 of uploaded attachment pages that count against the page limit shall be no more than the equivalent of 65 pages when printed by HRSA. 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.” If there are other attachments that do not count against the page limit, this will be clearly denoted in Section IV.2.vi Attachments.

The abstract is no longer an attachment that counts in the page limit. Additionally, Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. However, if you use an OMB-approved form that is not included in the workspace application package for HRSA-23-013, it will count against the page limit. Therefore, we 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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strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit.

It is important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-013 prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 10: Other Relevant Documents.

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

Program Requirements and Expectations

A. Application Process for Existing THCs Requesting Expansion of Resident FTEs and New THC Applicants

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

1. SF-424 R&R Application Package

2. A project abstract

3. A project narrative

4. A resident FTE request justification narrative

5. Standardized Work Plan

6. Staffing Plan and Job Descriptions for Key Personnel (Attachment 1)

7. Letters of Agreement from all major training partners, including required formal agreements from hospital partners (Attachment 2)

8. Residency Program Organizational Chart (Attachment 3)

9. Eligible Resident/Fellow FTE Chart (Attachment 4)

10. Accreditation documentation (Attachment 5)

11. Request for Funding Priorities—if new THC applicant is requesting funding priorities (Attachment 6)

12. Letters of Support (Attachment 7) 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-rr-app-guide.pdf

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13. THCGME Program Assurances (Attachment 8)

14. Documentation of Resident FTE Eligibility (Attachment 9)

B. THCGME Application Component Descriptions

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

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 – All Applicants 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 will count toward the page limitation. 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.

Please use the guidance below. It is the most current and differs slightly from that in Section 4.1.ix of HRSA’s SF-424 R&R Application Guide. Provide a summary of the application in the Project Abstract box of the Project Abstract Summary Form using 4,000 characters or less.

Address Project Director Name Contact Phone Numbers (Voice, Fax) Email Address Website Address, if applicable If requesting a funding preference, priority, or special consideration as outlined in

Section V. 2. of the program-specific NOFO, indicate here.

The Abstract must also include:

1. Name of the training program;

2. Discipline of the residency program;

3. Type of application—Expansion or New;

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

5. Year program first began training residents;

6. Organization website address;

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

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

8. Total resident FTE positions requested to be funded under this program for all post-graduate years of training, e.g., 12 (4-4-4) resident FTE above the baseline resident FTEs trained by the program in AY 2018-2019;

9. Resident FTE positions requested to be funded under this program for AY 2023- 2024, e.g., 4 (4-0-0); and

10. Rotation Sites: State if residents within the applicant residency program will perform rotations at a hospital rotation site(s) that has not provided resident training in any prior AY.

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

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

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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.

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

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

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

Describe the population served by the community-based ambulatory patient care site(s) that will host the residency program. Identify any rural and/or underserved populations that will be served through this project. Describe how your residency program is expected to improve the workforce and improve health in your community. You must also state the number of resident FTE(s) you are requesting for THCGME support. Provide data where available.

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

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

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

Provide a detailed work plan that demonstrates your ability to implement 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.Identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities, including development of the application and, further, the extent to which these contributors have the necessary competencies to serve the cultural, racial, linguistic and/or geographic diversity of the relevant populations and communities.

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

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

Describe your current accreditation status. Provide accreditation documentation in Attachment 5. If your residency program is in the process of obtaining accreditation and/or approval from the relevant accrediting body to expand the number of accredited positions within the program, describe the progress the program has made toward achieving accreditation and/or approval to expand residency training by the June 1, 2023 deadline specified in this NOFO. If your residency program has not yet begun training residents (i.e., currently has a baseline of zero (0) residents), describe the steps that you have taken to ensure that the program will be operational in AY 2023-2024.

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

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

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

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

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

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

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

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

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

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

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

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

Performance measures and data forms are subject to change each AY.

Describe the feasibility and effectiveness of plans for dissemination of project results.

Describe your process to track the practice patterns of trainees after program completion/graduation for up to 1 year, to include collection of trainees’ National Provider Identifiers (NPI).

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

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

Describe any additional sources of funding your residency program has or is expected to receive in the future.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion 4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed residency program. Provide information on your organization’s structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and http://bhw.hrsa.gov/grants/reporting/index.html

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meet program expectations. A residency program organizational chart should be provided in Attachment 3. The organizational chart should clearly identify the eligible community-based ambulatory patient care setting, the sponsoring institution, and all relevant partners, including training partners, required for the residency program. Letters of agreement from all major training partners should be included in Attachment 2. Additional letters of support may be submitted in Attachment 7.

Describe the distribution of funds to residency program partner training sites. If you are collaborating with a hospital for training, you must enumerate the steps that will be taken to ensure that resident FTEs submitted to the THCGME Program will not also result in Medicare GME or CHGME Program payments. The letter of agreement from any hospital partners should clearly delineate the organization’s understanding and plan to ensure there is no double payment for the same FTE.

If your organization is applying as part of a GME consortium the following information must be included…