BHW HRSA-23-124 (T99) MSE_FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Bureau of Health Workforce

Division of Medicine and Dentistry

Medical Student Education Program

Funding Opportunity Number: HRSA-23-124

Funding Opportunity Type(s): New

Assistance Listings Number: 93.680

Application Due Date: July 14, 2023 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 9, 2023

Anthony Anyanwu, MD Lead Public Health Analyst Phone: (301) 443-8437 Email: MSENOFO@HRSA.GOV

See Section VII for a complete list of agency contacts.

Authority: Consolidated Appropriations Act, 2023 (P.L. 117-328) mailto:MSENOFO@HRSA.GOV

HRSA-23-124 i

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 Medical Student Education (MSE) Program. The purpose of this program is to provide support to public medical schools in the top quintile of states with a projected primary care provider shortage in 20251 to expand or support education for medical students preparing to become physicians. This expansion can include funding for pre-entry programs and direct student support which help students be successful in medical school, as well as infrastructure development, maintenance, equipment, and minor renovations or alterations. The program is designed to prepare and encourage medical students in these schools to choose residencies and careers in primary care and serve tribal, rural, and/or medically underserved communities in those states after they complete their residency. Priority is given to applications from universities in states with the greatest number of federally-recognized tribes and from public universities with demonstrated private-public partnerships.

Funding Opportunity Title: Medical Student Education Program

Funding Opportunity Number: HRSA-23-124

Due Date for Applications: July 14, 2023

Anticipated FY 2023 Total Available Funding:

Up to $48,000,000

Estimated Number and Type of Award(s): Up to 12 grants

Estimated Annual Award Amount:

Not less than $1,000,000 and up to $4,000,000 per year for a 4-year period of performance

Cost Sharing/Match Required: Yes.

10 percent matching of the total annual amount of federal funds each year

1 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015. “State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016. Retrieved on January 12, 2023 from https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf.

http://www.hrsa.gov/ https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf

HRSA-23-124 ii

Period of Performance: September 30, 2023, through September 29, 2027 (4 years)

Eligible Applicants: Awards are limited to 12 public colleges of medicine in Alabama, Arkansas, Indiana, Kentucky, Mississippi, Missouri, Oklahoma, and Utah

Tribes and tribal organizations are not eligible.

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

HRSA-23-124 iii

Table of Contents

I. PROGRAM DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Standardized Work Plan Form

vi. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

V. APPLICATION REVIEW INFORMATION

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-23-124

I. Program Description

1. Purpose

This notice announces the opportunity to apply for funding under the Medical Student Education (MSE) Program.

The purpose of the MSE program is to provide support to public medical schools in the top quintile of states with a projected primary care provider shortage in 20252 to expand or support education for medical students preparing to become physicians. This expansion can include funding for pre-entry programs and direct student support which help students be successful in medical school, as well as for infrastructure development, maintenance, equipment, and minor renovations or alterations. The program is designed to prepare and encourage medical students in these schools to choose residencies and careers in primary care and serve tribal, rural, and/or medically underserved communities in those states after they graduate from residency.

This will be accomplished by supporting the development of premedical school programs and medical school curricula, clinical training site partnerships, and faculty training programs that encourage students to choose further study in medicine and educate medical students who are likely to choose career paths in primary care, especially for tribal, rural, and/or medically underserved communities.

The goal of the program is to increase the number of primary care physicians practicing in the top quintile of states with a projected primary care provider shortage in 2025.

Program Objectives

1. Recruit, retain, and graduate medical students from tribal, rural, and/or medically underserved communities who are interested in practicing in these areas following residency training.

2. Increase the number of medical school graduates who select residency programs in family medicine, general internal medicine, general pediatrics, or combination of internal medicine and general pediatrics to increase the primary care physician workforce in tribal, rural, and medically underserved communities.

3. Develop or enhance strategic partnerships, including one or more rotations in primary care such as at a Teaching Health Center or community-based setting, to collaborate on educational and training activities for the medical students.

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015. “State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016. Retrieved on January 12, 2023 from https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf.

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf

For more details, see Program Requirements and Expectations.

2. Background

The Medical Student Education Program is authorized by the Consolidated Appropriations Act, 2023 (P.L. 117-328).

A strong primary care system improves population health and reduces health disparities.3 There is a shortage of primary care physicians across the U.S. with some states experiencing more dramatic shortfalls that limit access to quality care.4 Premedical school post baccalaureate preparation has been shown to increase the number of medical students who choose primary care specialties and are more likely to practice in medically underserved areas than physicians nationally.5

The Association of American Medical Colleges reported that less than 10% of medical schools have more than four Native American students.6 A number of institutions developed programs to identify, mentor, and support promising underrepresented candidates to achieve the goal of becoming physicians.7 One such institution in Oklahoma has shown that recruiting and training students from rural and tribal communities is effective in addressing the challenges of underrepresentation and the physician workforce distribution.8

An important tool in supporting diversity in medicine are Postbaccalaureate Premedical programs.9 These programs make medical education opportunities more accessible by either providing access to prerequisite courses or providing academic enhancement to individuals who ordinarily would not be able to achieve the goal of becoming physicians.10 Medical students from rural and medically underserved areas are more likely than their

3 Pham, H, Greiner, A. The Importance Of Primary Care—And Of Measuring It. Health Affairs. (August 2019). Retrieved on June 5 , 2023 from https://www.healthaffairs.org/content/forefront/importance-primary-care-and-measuring.

4 Op. cit. U.S. Department of Health and Human Services.

5 Metz, A. M. (2017). “Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.” Teach Learn Med 29(3): 351-359. Retrieved on January 17, 2023 from https://nihlibrary.ors.nih.gov/NIHLibrary/genHRSAticket.asp?url=https://www.ncbi.nlm.nih.gov/pubmed/2863 2012.

6 Murphy, B. New effort to help Native American pre-meds pursue physician dreams. (January 13, 2022).

American Medical Association. Retrieved on March 13, 2023 from https://www.ama-assn.org/education/medical-school-diversity/new-effort-help-native-american-pre-meds-pursue-physician-dreams.

7 Green, A, Konopasky, A, Dong, T, Saguil, A, Torre, D, Durning, S. Military Medicine. Expanding Opportunities: An Evaluation of Uniformed Services University’s Premedical Program for Enlisted Service Members. (September-October 2022). Volume 187. Retrieved on January 17, 2023 from https://doi.org/10.1093/milmed/usab125 8 Bray, N. Why the needs for rural and Native American physicians are interconnected. (November 18, 2021). The DO. Retrieved on March 13, 2023 from https://thedo.osteopathic.org/2021/11/why-the-needs-for-rural-and-native-american-physicians-are-interconnected/.

9 Op. cit. Metz, A. M. (2017).

10Op. cit. Metz, A. M. (2017).

https://nihlibrary.ors.nih.gov/NIHLibrary/genHRSAticket.asp?url=https://www.ncbi.nlm.nih.gov/pubmed/28632012 https://nihlibrary.ors.nih.gov/NIHLibrary/genHRSAticket.asp?url=https://www.ncbi.nlm.nih.gov/pubmed/28632012 javascript:;

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https://doi.org/10.1093/milmed/usab125 peers to practice medicine in tribal, rural, and/or medically underserved areas.11 These students are also more likely to have socioeconomic barriers to a medical career.12 Scholarships may help students overcome financial barriers to a career in medicine.

Providing scholarships to medical students may incentivize the medical students to choose primary care residencies, particularly when they begin to finalize their choices and apply for residency.

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 MSE Program for Fiscal Year 2023:

Pre-entry Programs: For the purposes of this NOFO means a variety of preparatory reinforcement and enrichment programs including the postbaccalaureate premedical school program, often directed at meeting the needs of students from minority or underserved backgrounds to be successful in the medical school admissions process and in medical school.

Postbaccalaureate Premedical Programs: For the purposes of this NOFO means a program that gives college graduates the opportunity to complete undergraduate science courses in preparation for application to medical school and other related professional schools.

Scholarship: means provision of financial support in the form of tuition, fees, and other educational costs.

Teaching Health Center: 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(s) of applications sought: New

HRSA will provide funding in the form of a grant.

11 Atance, J, Mickalis, M, Kincade, B. Educational Intervention in a Medically Underserved Area. (2018) Journal of American Osteopathic Association. Retrieved on January 17, 2023, from Educational Intervention in a Medically Underserved Area - PubMed (nih.gov).

12IBID

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://pubmed-ncbi-nlm-nih-gov.ezproxyhhs.nihlibrary.nih.gov/29582056/ https://pubmed-ncbi-nlm-nih-gov.ezproxyhhs.nihlibrary.nih.gov/29582056/

2. Summary of Funding

HRSA estimates up to $48,000,000 to be available annually to fund 12 recipients. You may apply for not less than $1,000,000 and up to a ceiling amount of $4,000,000 per year, reflecting direct and indirect, facilities and administrative costs. Your request for each subsequent year of the period of performance cannot exceed your year 1 request.

The period of performance is September 30, 2023, through September 29, 2027 (4 years). Funding beyond the first year is subject to the availability of appropriated funds in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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

Limitations on Indirect Cost Rates

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

III. Eligibility Information

1. Eligible Applicants Per statute, funds must be awarded to public institutions of higher education in states in the top quintile of states with a projected primary care provider shortage in 2025. HRSA has determined that the eligible applicants for this funding opportunity are limited to accredited public colleges of medicine in Mississippi, Alabama, Kentucky, Oklahoma, Utah, Arkansas, Missouri, and Indiana.

The “State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013- 2025” indicate there are 37 states with a shortage in 2025.13 The top quintile of 37 states is 7.4. However, because the difference in adequacy scores between the seventh and eighth position was less than one percentage point, HRSA made a decision to include the

13 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015. “State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016. Retrieved on January 12, 2023 from https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-state-projections2013-2025.pdf top eight states: Mississippi, Alabama, Kentucky, Oklahoma, Utah, Arkansas, Missouri, and Indiana.

HRSA then identified accredited Osteopathic and Allopathic medical schools in those eight states using the Commission on Osteopathic College Accreditation (COCA) and Liaison Committee on Medical Education (LCME), selecting only those that identified as public, non-profit colleges of medicine. This resulted in 12 public, non-profit colleges of medicine within the eight states that are potentially eligible for MSE funding. HRSA has identified the following accredited public colleges of medicine in these eight states in the table below.

The listing below is not intended to foreclose applications by applicants that can demonstrate to HRSA that they are accredited public colleges of medicine in one of the eight listed states. HRSA may consider any application that does not meet the eligible applicant requirement non-responsive and may consider it ineligible for funding under this notice.

Eligible Public Medical Colleges in Top Quintile of States with a Projected Primary Care Provider Shortage in 202514

State Public Medical School City

Alabama University of Alabama School of Medicine Birmingham

Alabama University of South Alabama College of Medicine

Mobile

Arkansas University of Arkansas for Medical Sciences College of Medicine

Little Rock

Indiana Indiana University School of Medicine Indianapolis

Kentucky University of Louisville School of Medicine Louisville

Louisville

Kentucky University of Kentucky College of Medicine Lexington

Mississippi University of Mississippi School of Medicine Jackson

Missouri University of Missouri-Columbia School of Medicine

Columbia

Missouri University of Missouri-Kansas City School of Medicine

Kansas City

Oklahoma University of Oklahoma College of Medicine Oklahoma City

Oklahoma Oklahoma State University College of Osteopathic Medicine

Tulsa

Utah University of Utah School of Medicine Salt Lake City

Tribes and tribal organizations are not eligible.

2. Cost Sharing/Matching

Matching is required for this program. The MSE Program authorization requires an amount not less than ten percent matching of the total annual amount of federal funds provided each year in the grant to each award recipient. Higher degrees of matched funding are allowable and may help award recipients develop more sustainable plans and achieve greater health workforce outcomes. Matching funds are any non-federal funds that contribute to the project purpose and objectives, such as in-kind faculty contributions, facilities and related costs, and contributions from partnerships (45 CFR 75.306).

Applications that fail to address cost sharing/matching requirements will be deemed ineligible and not considered for funding under this notice.

3. Other

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

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

• Fails to satisfy the matching requirement.

• This award must not be less than $1,000,000 and up to $4,000,000.

Beneficiary Eligibility Requirement

An eligible beneficiary (participant) receiving support from grant funds under this program must be a citizen, non-citizen national of the United States, an individual lawfully admitted for permanent residence to the United States, or any other “qualified alien” under section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104-193, as amended.

Multiple Applications

NOTE: Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date as the final and only acceptable application. No more than one application per organization or campus with the same UEI number will be funded. The applicant may include a request for resources for a branch campus or similar entity as part of their 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 Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov: APPLICANT SYSTEM-TO-SYSTEM.

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

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-124 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, and certifications. You must submit the information outlined in 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 this NOFO and HRSA’s SF-424 R&R Application Guide. You must submit the application in the English language and express budget figures in 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 to assist you in completing your application.

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

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. HRSA will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-124 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete and validated by Grants.gov under HRSA-23-124 before 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 10-15: 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 Applicants must expand and support medical education by incorporating the following activities:

1. Develop, enhance, and implement Postbaccalaureate Premedical Programs that support the transition from undergraduate to medical school, and plan and implement targeted outreach to increase enrollment of medical students with particular focus on students from tribal, rural, and/or medically underserved 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 communities who are most likely to go on to practice in tribal, rural, and/or medically underserved areas.

2. Ensure that at least one or more of the clinical sites for medical students are in primary care setting such as a Teaching Health Center or other community-based setting that has a primary care residency program (general internal medicine, general pediatrics, family medicine, and combination of internal medicine and general pediatrics (med/peds)).

3. Provide scholarships for medical students who intend to practice in primary care tribal, rural, and/or medically underserved areas.

4. Develop and implement new and/or expanded curricula that implements a defined set of clinical, didactic, and community-based training activities with an emphasis on practicing in tribal communities, rural communities and/or medically underserved communities, and addresses how to meet the needs of vulnerable populations.

5. Develop a plan to collect post-graduation residency choice data on medical students for one year after program completion.

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:

Applicants are expected to develop and upload (in Attachment 9) a disparities impact statement.

Award recipients must adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20-12 when evaluating their program.

Award recipients are required to participate in federally designed evaluations to assess program effectiveness and efficiency upon request.

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. See Form Alert in Section IV.1 of this NOFO. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide. When applicable, identify if a funding priority/ preference is being requested.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria.

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

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

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

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that trainees would ultimately serve.

1. Briefly describe the purpose of your proposed project, and the nature of the primary care physician shortages in your tribal, rural, and/or medically underserved areas.

2. Describe need for curricula that implements a defined set of clinical, didactic, and community-based training activities with an emphasis on practicing in tribal communities, rural communities and/or medically underserved communities and how to meet the needs of underserved populations in your community.

3. Describe how Postbaccalaureate Premedical Programs will increase enrollment of the number of medical students from your tribal, rural, and/or medically underserved areas.

4. Describe the medical students’ clinical training rotation site(s) in Attachment 4.

5. Describe the characteristics of any current or new partners that you will engage to support the purposes of this project.

6. Include a Disparities Impact Statement as Attachment 9, which is an instrument used to measure and describe how training will support trainees’ capacity to meet the needs of underserved populations.

7. Use and cite demographic data whenever possible to support the information provided.

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

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

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion(a) 2 (a) In your application, provide a detailed work plan that demonstrates your experience or ability implementing a project of the proposed scope. Your work plan must be submitted through the Standardized Work Plan Form located in the Grants.gov workspace. Applicants should include a brief narrative element outlined below, in addition to completing the Standardized Work Plan.

In your work plan:

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

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

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

The Standardized Work Plan form is organized by budget period and must include all activities and deliverables for each objective and program goal. The program goal for this NOFO must be entered in the Program Goal section of the Standardized Work Plan form. The goal of the MSE program is to increase the number of primary care physicians practicing in the top quintile of states with a projected primary care provider shortage in 2025. The program objectives in this NOFO must be entered in the objectives section of the Standardized Work Plan. Sub-objectives under each NOFO objective can be tailored to your project needs.

Form instructions are provided along with the Standardized Work Plan form and are included in the application package found on Grants.gov. The Project Director must register in the HRSA electronic handbook (EHB) once award is made, to review and finalize the completed Standardized Work Plan

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

Propose methods that you will use to address the stated needs and meet the program goal and three program objectives in this NOFO.

In the Methodology section of your application, you must describe:

1. How you will develop, enhance, and implement Postbaccalaureate Premedical programs that support the transition from undergraduate to medical school, and plan and implement targeted outreach to increase enrollment of medical students from disadvantaged communities.

2. How you will increase the number of medical school graduates who select primary care residency programs and want to practice in tribal, rural, and medically underserved communities.

3. How you will develop and implement at least one or more primary care clinical rotations for medical students such as at a Teaching Health Center or other community-based setting that has a primary care residency program (general internal medicine, general pediatrics, family medicine, and combination of internal medicine and general pediatrics (med/peds).

4. How you will provide scholarships for medical students to encourage applications to a primary care residency program (general internal medicine, general pediatrics, family medicine, and med/peds) or medical students completing a clerkship in primary care serving tribal, rural, and/or medically underserved communities and intend to practice in primary care following completion of residency.

5. How you will develop and implement curricular content and clinical experiences that influence medical students’ decision to select primary care practice in tribal, rural, and/or medically underserved communities.

6. How you will develop or enhance strategic partnerships, including with Teaching Health Centers, to collaborate on educational and training activities for the medical students.

7. How you will increase the capacity of the faculty who train and mentor the medical students, including recruitment and retention activities.

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 including, but not limited to:

1. Describe the challenges you may encounter in achieving the program specific requirements including developing of Postbaccalaureate Premedical programs, incorporating at least one or more of medical students’ clinical rotations in primary care such as at a Teaching Health Center or other community-based setting, and distribution of scholarships to medical students within one-year of receipt of the Notice of Award.

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

3. Describe proposed solutions to the challenges that are identified.

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)

In your application:

1. Describe the data collection strategy and tools to accurately collect, manage, analyze, store, and track/report data, including HRSA-required data (e.g., assigned skilled staff, data management software) to measure process and outcomes, and explain how the data will be used to inform program development and training.

2. Document the procedure for assuring the data collection, management, storage, and reporting of individuals participating in the program, including after graduation and their choice of residency for up to one year.

3. Describe your strategy for collecting, managing, and reporting required performance data in an accurate and timely manner. At the following link, you will find examples of the current reporting forms required for the MSE Program:

http://bhw.hrsa.gov/grants/reporting/index.html. Note: Performance measures and data forms are subject to change each academic year.

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

4. Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards meeting the goals and objectives of the project. Evaluations must adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20- 12.

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

Propose a plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to highlight key elements of your grant project and include the following:

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

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

ORGANIZATIONAL INFORMATION, RESOURCES, AND CAPABILITIES --

Corresponds to Section V’s Review Criterion 4

This section will help reviewers understand the organization that would receive funding for training.

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

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

3. A project organizational chart is requested in Attachment 3. This chart should delineate the relationships, roles, and responsibilities of all partner organizations, including Teaching Health Center(s) that has a primary care residency program (general internal medicine, general pediatrics, family medicine, and combination of internal medicine and general pediatrics (med/peds)) and training program partners.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 1 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED

Biographical Sketches

Provide a biographical sketch for key faculty/staff contributing to the project. The information must be current, indicating the individual’s position and sufficient detail to https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/200386/hhs-evaluation-policy.pdf https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf assess the individual’s qualifications for the position being sought and consistent with the position description. Each biographical sketch should be limited to one page as they count toward the overall page limit. Include all degrees and certificates.

Biographical sketches should include the following information:

• Senior/key personnel name

• Position Title

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

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

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

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

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

When applicable, biographical sketches must include training, language fluency and experience working with populations that are culturally and linguistically different from their own.

Project Director The Project Director must be a board-certified physician, employed by the applicant organization, and dedicate at least 20 percent of his/her time (may be in-kind or funded by grant funds) to grant activities.

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

Your project will be supported by both the grant award and the non-federal matching funds. You must apply for at least $1,000,000 per year but no more than $4,000,000 per year of federal funding, plus you must also include 10 percent non-federal matching funds.

You will be using the SF Research and Related Budget (Total Fed + Non-Fed) form for this program to show both federal funds and non-federal matching funds (10 percent).

Provide a separate SF-424 R&R (Total Fed + Non-Fed) line-item budget form for each 12-month increment of activity (for each budget year of the four-year period of performance).

Matching

Matching is required for this program. The authorizing legislation requires not less than ten percent match in non-federal contributions for this grant each budget period.

Applicant organizations must match at least 10 percent of federal funds provided under this grant either in cash or in-kind. In-kind contributions may include cost of housing, equipment, services, faculty, and preceptors who are not supported by grant funds. The 10 percent may also be provided from state, local, or private sources.

Subawards/subcontracts

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

The R&R Subaward Budget Attachment Form limits the number of attachments for subawards to 10. If you need to include additional line-item budget forms, upload the attachment in R&R Other Project Information Form, block 12 “Other Attachments.” These additional line-item budget forms for subawards will not count against the page limit. Note that any additional budget justifications (i.e., back-up information) are included in the page limit.

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

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

As required by the Consolidated Appropriations Act, 2023. (P.L. 117-328), Division H, § 202 “None of the funds appropriated in this title shall be used to pay the salary of an http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.”. Effective January 2023, the salary rate limitation is $212,100. Note that these or other salary rate limitations may apply in the following fiscal years, as required by law.

Use of Funds

All applicants must provide a plan and budget reflective of the

• number of medical students that are projected to receive scholarships under this grant per year;

• cost of developing and implementing Postbaccalaureate Premedical programs;

• cost associated with developing and implementing clinical rotations; and

• Cost for infrastructure development, maintenance, equipment, and minor renovations or alterations.

Infrastructure development – for this NOFO means sufficient personnel, financial resources, physical facilities, equipment, and clinical, instructional, informational, technological, and other resources readily available and accessible across all locations to meet its needs and to achieve its goals.

Maintenance – In grant regulations means, “Costs incurred for utilities, insurance, security, necessary maintenance, janitorial services, repair, or upkeep of buildings and equipment (including Federal property unless otherwise provided for) which neither add to the permanent value of the property nor appreciably prolong its intended life, but keep it in an efficient operating condition, are allowable.” 45 CFR 75.452

Equipment and minor A&R are defined in the SF-424 R&R Application Guide.

Applicants will show these expenses as direct costs in Section F. Other Direct Costs of the SF Research and Related Budget (Total Fed + Non-Fed) form.

iv. Budget Justification Narrative

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

All budgets must provide sufficient details to fully explain and justify the resources needed to accomplish all program objectives.

The budget justification narrative must describe all line-item federal funds (including subawards), and 10 percent matching non-federal funds proposed for this project. Please note: all budget justification narratives count against the page limit. In addition, the MSE Program requires the following:

Program Evaluation and Impact Costs: You must ensure that you have dedicated sufficient funds in your budget to conduct the required program evaluation and impact as described in Section V’s Review Criterion.

Participant/Trainee Support Costs: List the number of participants/trainees receiving scholarships. Scholarships include tuition/fees/health insurance, stipends, travel.

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

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

Subawards/Contractual Costs: As applicable, provide a clear explanation as to the purpose of each subaward/contract, how the costs were estimated, and the specific contract deliverables. You are responsible for ensuring that their institution has in place an established and adequate procurement system with fully developed written procedures for awarding and monitoring all contracts.

Reminder: Award recipients must notify potential subrecipients that entities receiving subawards must be registered in SAM and provide the award recipient with their UEI number.

v. Standardized Work Plan Form As part of the application package submitted through Grants.gov, you must complete and electronically submit the Standardized Work Plan Form by the application due date. Ensure it includes all the information detailed in Section IV.2.ii. Project Narrative.

vi. Attachments Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Your indirect cost rate agreement and proof of non-profit status (if applicable) will not count toward the page limit. Clearly label each attachment. You must upload attachments into the application. HRSA and the objective review committee will not open/review any hyperlinked attachments.

Attachment 1: Staffing Plan and Job Descriptions for Key Personnel (see Section 4.1.vi. of HRSA’s SF-424 R&R Application Guide)(Required)

Keep each job description to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff. Also include a description of your organization’s timekeeping process to ensure that you will comply with the federal standards related to documenting…