BHW HRSA-24-051 (T91) THCGME MOD_2.pdf

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Medicine and Dentistry

Teaching Health Center Graduate Medical Education (THCGME) Program

Funding Opportunity Number: HRSA-24-051 Funding Opportunity Type(s): Competing Continuations

Assistance Listings (AL/CFDA) Number: 93.530

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Application Due Date: January 12, 2024 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 9, 2023

Modified January 2, 2024 to update project officer contact information.

Modified December 22, 2023: Extending the original due date to January 12th, 2024 for eligible applicants who were unable to submit by the original due date.

This will allow continuous support to funded THCGME graduate medical education programs and avoid reduction in training slots. Updated the approval letter date from November 14 to January 29, 2024.

Thuy-Tien Le, D.O.

Project Officer, Division of Medicine and Dentistry Telephone: (301) 480-7777 Email: Tle@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]

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508 Compliance Disclaimer Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff above or in Section VII. Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2024 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 through this opportunity will be made to support maintenance of HRSA-funded filled resident Full-Time Equivalent (FTE) positions for existing HRSA THCGME Program payment recipients.

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

Funding Opportunity Number: HRSA-24-051

Due Date for Applications: January 12, 2024

Anticipated Total Available

FY 2024 Funding:

$126.5 million

Estimated Number and Type of Award(s): Approximately 57 awards to Eligible Applicants.

Cost Sharing/Match Required: No

Period of Performance:

July 1, 2024, through June 30, 2028

(4 years)

Eligible Applicants: An eligible entity is a FY 2020 HRSA THCGME Program payment recipient.

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

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Application Guide

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

Technical Assistance HRSA will hold a technical assistance (TA) webinar for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/ to learn more about the resources available for this funding opportunity.

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

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND PAYMENT (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

ii. Budget

iii. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: 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 continuation awards to support maintenance of filled resident Full-Time Equivalent (FTE) positions that are funded by HRSA under announcement HRSA-20-011. Note: application through this FY 2024 Notice of Funding Opportunity (NOFO) will extend the period of performance for positions funded under HRSA-20-011 for an additional four (4) years.

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

Funding through this opportunity will support maintenance of approved HRSA-funded resident FTE positions for existing HRSATHCGME Program payment recipients only. Applications seeking support for an expanded number of resident FTE positions and/or establishment of new resident FTE positions will not be considered under this notice.

Awards made through this notice may be used 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).

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 FTE’s time. THCGME funds must be used for program activities. 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.

Organizations applying for continued support for more than one residency program must submit a separate application for each unique program.

2. Background

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

The THCGME Program aims to strengthen the primary care workforce by supporting medical and dental primary care training programs that train physicians and dentists in community-based settings with a focus on rural and underserved communities. The program uses 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 more likely to

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practice in underserved settings after graduation when compared to residents who did not train in health centers.1 There is also evidence that physicians who receive training in community and underserved settings are more likely to practice in similar settings.2,3

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 2024:

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 Teaching Health Center (THC) means a THC that sponsors 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)]) and received a payment under the HRSA THCGME Program for a previous fiscal year.

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

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

New Teaching Health Center (THC) means a THC that sponsors a “new approved graduate medical residency training program” as defined in section 340H(j)(2) of the PHS

1 Chen C, Chong N, Luo Q, Park J. Community Health Center Residency Training: Improving Staffing, Service, and Quality. Family Medicine. 2021; 53(8):689-696.

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

3 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.

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

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Act [42 U.S.C. 256h(j)(2)]) and has not received a payment under the HRSA THCGME Program for a previous fiscal year for that program.

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 Direct Medical Education (DME) and Indirect Medical Education (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, 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 Payment (Award)

Type of applications sought: Competing continuations

Funding will be provided in the form of a formula-based payment (also referred to as an “award” herein).

2.Summary of Funding

This NOFO is contingent on availability of funding. The FY 2024 Budget request includes approximately $126.5 million to be available to fund approximately 57 awards under this Notice of Funding Opportunity. The $126.5M amount available through this funding opportunity represents the amount needed to fund the FTEs funded in 2020 (HRSA-20-011) that will be completing their period of performance in June 2024.

The period of performance is July 1, 2024, through June 30, 2028 (4 years). Funding beyond FY 2024 is dependent on the availability of appropriated funds for the HRSA THCGME Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

The FY 2024 HRSA THCGME Program payment is formula-based and provides a payment for both DME and IME expenses. The anticipated FY 2024 interim payment rate is $160,000 per resident FTE. In subsequent fiscal years, the payment rate may change due to available appropriations and/or changes in payment methodology.

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HRSA may adjust recipient funding levels beyond the first year if they are unable to fully succeed in achieving the goals listed in their applications.

Reconciliation All HRSA 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.

Awardees are responsible for the accuracy of FTE data submitted to HRSA and may be audited by HRSA to ensure the accuracy and completeness of the information submitted. In addition, Section 340H(e) of the PHS Act [42 U.S.C. 256h(e)] describes the relationship between THCGME Program funding and GME payments made by Medicare and the Children’s Hospitals Graduate Medical Education (CHGME) payment 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 HRSA THCGME Program. HRSA requires applicants to coordinate closely with affiliated teaching hospitals in order to avoid over-reporting of THCGME supported FTE positions. Over-reporting of FTEs, including ineligible FTEs, and subsequent over-payment will result in the recoupment of THCGME payments.

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

III. Eligibility Information

1. Eligible Applicants

Existing HRSA THCGME Program payment recipients must continue to meet all of the following criteria in order to be considered eligible for HRSA THCGME funding. Program payment recipients that fail to meet any eligibility criteria will not be considered for funding under this announcement.

A. Eligible Entities

An eligible entity is a current THCGME Program payment recipient that was awarded funding under HRSA-20-011 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.

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

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

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

B. Accreditation/Institutional Sponsorship

The eligible community-based ambulatory patient care center or GME consortium, must be accredited as one of the eligible primary care specialties programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics-gynecology, general dentistry, pediatric dentistry, and geriatrics. In addition, it 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.

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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). Applicant residency programs must be prepared to train residents starting on the July 1, 2024 project period start date.

Entities that are not community-based ambulatory patient care centers, 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. However, teaching hospitals and academic institutions have proven to be successful partners of THCs and members of established GME consortia. Where such partnerships are formed, the GME consortium must serve as the institutional sponsor of the residency program.

3. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

4. Other

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

Other Funding Sources

HRSA THCGME funds must be used for program activities. Funds from a HRSA THCGME award may not be used to 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 purpose/the same resident FTE’s time. 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.

Multiple Applications

NOTE: Existing HRSA THCGME Program payment recipients applying for continued HRSA THCGME funding to support multiple residency programs MUST submit a separate application for each individual residency program.

Funding through this opportunity will support maintenance of approved HRSA-funded resident FTE positions for existing HRSA THCGME Program payment recipients only at their approved FTE levels. Applications seeking support for an expanded number of resident FTE positions and/or establishment of new resident FTE positions will not be considered under this announcement.

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.

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

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.

IV. Application and Submission Information

1. Address to Request Application Package HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form and use the Project Abstract Summary Form 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-24-051 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 http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html 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 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 budget figures expressed 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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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 7: 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

Program Requirements

Continuation Application Process for Existing FY 2020 HRSA THCGME Program Payment Recipients

In accordance with Section 4 of HRSA’s SF-424 R&R Application Guide, existing HRSA THCGME Program payment recipients are required to submit the following:

1) SF-424 R&R Application Package

2) A project abstract

3) Job Descriptions for Key Personnel (Attachment 1)

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

5) Residency Program Organizational Chart (Attachment 3)

6) Eligible Resident/Fellow FTE chart (Attachment 4)

7) Accreditation documentation (Attachment 5)

8) THCGME Program Assurances (Attachment 6)

Since applicants are submitting requests to continue their programs, they are not required to submit a project narrative, resident FTE request justification, or staffing plan and personnel requirements unless they have updates from their application under HRSA-20- 011.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the assurances, certifications, and abstract), include the following:

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.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Faspe.hhs.gov%2Fsites%2Fdefault%2Ffiles%2Fmigrated_legacy_files%2F200386%2Fhhs-evaluation-policy.pdf&data=05%7C01%7CSLevant%40hrsa.gov%7C4da63050dfbf4d87051308db18eb40c0%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638131170900085621%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=xyhOds0iigSBn0DWngs5JJpgIwe3ZEkdzU6LN7NIZN4%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.whitehouse.gov%2Fwp-content%2Fuploads%2F2020%2F03%2FM-20-12.pdf&data=05%7C01%7CSLevant%40hrsa.gov%7C4da63050dfbf4d87051308db18eb40c0%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638131170900241838%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=JN8M4caEcCscyj3As0acTWMkdTnvuPa2P6Pg0ANItf0%3D&reserved=0

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i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment. See Form Alert in Section IV.1 Application Package.

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 Email Address Website Address, if applicable

The Abstract must also include:

1. Name of the medical/dental residency training program;

2. Specialty of the residency training program;

3. 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 training program alone or as part of a GME consortium;

4. Year program first began training residents;

5. A brief overview of the residency training 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;

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

7. Resident FTE positions requested to be funded under this program for AY 2024- 2025, e.g., 12 (4-4-4); and

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

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 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. Include all degrees and certificates.

Biographical sketches should include the following information:

• Senior/Key Person name

• Position Title

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• 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 current position. List any honors. Include current 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.

ii. Budget

The HRSA THCGME Program is a formula-based payment program that does not require submission of a formal budget. Please note that the SF-424 R&R submission package contains budget forms that are required to be submitted.

Applicants are advised to put in a “0” for this form and then upload a blank document as an attachment to complete the package.

iii. Attachments

Provide the following items in the order specified below to complete the content of the application. Clearly label each attachment. You must upload attachments into the application. Any hyperlinked attachments will not be reviewed/opened by HRSA.

Attachment 1: Job Descriptions for Key Personnel Keep each job description to one page in length. Include the role, responsibilities, and qualifications of proposed project staff.

Attachment 2: Letters of Agreement, Memoranda of Understanding, and/or Description(s) of Proposed/Existing Contracts (project-specific)

Provide any documents that describe working relationships between your organization and other entities and programs cited in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe your organization and the contractors’ roles and any deliverable. Letters

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of agreement from hospital training partners must address understanding and steps to ensure that THCGME resident FTEs will not also be submitted to Medicare GME or the CHGME Program for the purposes of receiving GME payments.

Affiliation agreements with hospitals receiving reimbursement from the Centers for Medicare & Medicaid Services (CMS) for resident training time must include acknowledgement that new residents rotating at these sites will trigger the CMS resident FTE cap building period. Letters of agreements are required to be signed and dated.

NOTE: Abbreviated/shortened documentation of relevant Letters of Agreement, Memoranda of Understanding, and/or Description of Proposed/Existing Contracts is acceptable in this NOFO. Documentation provided should be clear, concise, and address all requirements described above.

Attachment 3: Residency Program Organizational Chart

Provide a one-page figure that depicts the organizational structure of the residency program, including the community-based ambulatory outpatient care center and all major training partners.

Attachment 4: Eligible Resident/Fellow FTE Chart

Upload a copy of the completed Eligible Resident/Fellow FTE Chart. The chart must include the total resident training numbers from AY 2018-2019 through AY 2023- 2024, planned total resident training numbers for AY 2024-2025 through AY 2026- 2027, and planned THCGME resident FTE for AY 2024-2025 through AY 2026-2027.

THCGME-supported resident FTEs documented in this chart may not exceed the number stated in your most recent HRSA THCGME Program Resident FTE Approval Letter; requests for resident FTEs beyond this number will not be considered through this announcement.

Please see Appendix B for the OMB-approved form and the form completion instructions. Limitations apply to resident FTEs that can be submitted for THCGME payments. See Appendix A for more information.

Attachment 5: Accreditation Documentation

Provide documentation of residency program accreditation from the appropriate accrediting body (ACGME or CODA). Documentation must clearly identify the residency program’s institutional sponsor, number of approved resident positions, dates of accreditation, and any noted citations (if applicable).

Attachment 6: THCGME Program Assurances

Appendix A provides THCGME Program information on resident FTE time that is allowable to receive THCGME payments. You must submit a signed THCGME Program Assurances document confirming that you have reviewed and will comply with Appendix A.

Attachment 7: Other Relevant Documents – All Applicants (as applicable)

Include here any other document that is relevant to the application.

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

Effective April 4, 2022:

• The UEI assigned by SAM has replaced the Data Universal Numbering System (DUNS) number.

• Register at SAM.gov and you will be assigned a UEI.

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

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

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

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

• System for Award Management (SAM) (https://sam.gov/content/home | SAM.gov Knowledge Base)

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

Effective March 3, 2023, individuals assigned a SAM.gov Entity Administrator role must be an employee, officer, or board member, and cannot be a non-employee. This change is to ensure entities are in control of who has permission to control roles within their entity.

Here’s what this means:

• Entity Administrators assigning roles to non-employees will only be able to assign a Data Entry role or lower.

• Any entities assigning Entity Administrator roles using an Entity Administrator Role Request Letter (formerly called “notarized letter”) will no longer be able to assign the Entity Administrator role to a non-employee.

https://sam.gov/content/home https://sam.gov/content/home https://sam.gov/content/home https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.fsd.gov/gsafsd_sp?id=gsa_kb_view2&kb_id=f66d8e6cdb76d4100d73f81d0f9619c6 https://www.grants.gov/ https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fsd.gov%2Fgsafsd_sp%3Fid%3Dkb_article_view%26sysparm_article%3DKB0017347&data=05%7C01%7CGLipton%40hrsa.gov%7C1f1974d9918c46f8ea7b08db16711558%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638128447164646983%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=njVzaJTqUYleNphpzJS52x%2BSILPkvOFTju6LLDwsQpA%3D&reserved=0

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• Entity Administrator roles assigned to non-employees will be converted to Data Entry roles. With a Data Entry role, non-employees can still create and manage entity registration data entry but cannot manage roles.

• If you are an entity using a non-employee or if you are a non-employee working with an entity to manage registrations, please read (and share) more about this change on our blog to know what to expect.

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

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

4. Submission Dates and Times

Application Due Date The due date for applications under this NOFO is January 12, 2024 at 11:59 p.m.ET.

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

5. Intergovernmental Review

The THCGME Program is not subject to the provisions of Executive Order 12372, as implemented by 45 CFR part 100.

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

6. Funding Restrictions

You may request support for resident FTEs for a period of performance of up to 4 years and up to the limits set in Section II.2 of this notice. Awards to support projects beyond FY 2024 will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the Federal Government.

Funds for residency program development, such as completing ACGME or CODA accreditation requirements, are not available under this notice.

The General Provisions in Division H of the Consolidated Appropriations Act, 2023 (P.L.

117-328) apply to this program. See Section 4.1 of HRSA’s SF-424 Application Guide for additional information. Note that these or other restrictions will apply in following fiscal years, as required by law.

You are required to have the necessary policies, procedures, and financial controls in place to ensure that your organization complies with all legal requirements and restrictions https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fbuy.gsa.gov%2Finteract%2Fcommunity%2F47%2Factivity-feed%2Fpost%2Fa14726f4-e2a9-47b3-80ec-7ceff5108706%2FA_Change_in_SAM_gov_will_Affect_Access_for_Some_Entity_Administrators&data=05%7C01%7CGLipton%40hrsa.gov%7C1f1974d9918c46f8ea7b08db16711558%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638128447164646983%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=U0nzH2tFpFjh0lZL17c7eqQyhrMCSCO%2BE8ovkHHX9MQ%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fbuy.gsa.gov%2Finteract%2Fcommunity%2F47%2Factivity-feed%2Fpost%2Fa14726f4-e2a9-47b3-80ec-7ceff5108706%2FA_Change_in_SAM_gov_will_Affect_Access_for_Some_Entity_Administrators&data=05%7C01%7CGLipton%40hrsa.gov%7C1f1974d9918c46f8ea7b08db16711558%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638128447164646983%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=U0nzH2tFpFjh0lZL17c7eqQyhrMCSCO%2BE8ovkHHX9MQ%3D&reserved=0 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/sf424guide.pdf

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applicable to the receipt of federal funding including any applicable statutory restrictions.

Like all other applicable requirements, the effectiveness of these policies, procedures, and controls is subject to audit.

Be aware of the requirements for HRSA recipients and subrecipients at 2 CFR § 200.216 regarding prohibition on certain telecommunications and video surveillance services or equipment. For details, see the HRSA Grants Policy Bulletin Number: 2021-01E.

All program income generated as a result of awarded funds must be used for approved project-related activities. Any program income earned by the recipient must be used under the addition/additive alternative. You can find post-award requirements for program income at 45 CFR § 75.307.

V. APPLICATION REVIEW INFORMATION

1. Review Criteria

Existing HRSA-funded FY 2020 THCGME Program payment recipients must complete and submit all documentation listed in Section IV.2.A of this NOFO. Submissions will be reviewed and evaluated by HRSA staff to confirm that the applicant meets eligibility requirements and to validate the number of resident FTE requested for continued THCGME support.

2. Assessment of Risk

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

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

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

https://www.hrsa.gov/sites/default/files/hrsa/grants/manage/grants-policy-bulletin-2021.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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HRSA is required to review and consider any information about your organization that is in the Responsibility/Qualification Reports or the Federal Awardee Performance and Integrity Information System (FAPIIS). You may review and comment on any information about your organization that a federal awarding agency previously entered. HRSA will consider any of your comments, in addition to other information in FAPIIS in making a judgment about your organization’s integrity, business ethics, and record of performance under federal awards when completing the review of risk posed by applicants as described in 45 CFR § 75.205 HHS Awarding Agency Review of Risk Posed by Applicants.

HRSA will report to FAPIIS a determination that an applicant is not qualified (45

CFR § 75.212).

VI. Award Administration Information

1. Award Notices

HRSA intends to issue approval letters to successful applicants by January 29, 2024, to allow programs to recruit residents for the 2024-2025 AY that will begin July 1, 2024.

HRSA will release the Notice of Award (NOA) and make funding available on or around the start date of July 1, 2024. See Section 5.4 of HRSA’s SF-424 R&R Application Guide for additional information.

2. Administrative and National Policy Requirements

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

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

• all applicable provisions of 45 CFR part 75, currently in effect or implemented during the period of the award,

• other federal regulations and HHS policies in effect at the time of the award or implemented during the period of award, and

• applicable statutory provisions.

Accessibility Provisions and Non-Discrimination Requirements Should you successfully compete for an award, recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex (including gender identity, sexual orientation, and pregnancy). This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS Office for Civil Rights (OCR) provides guidance on complying with civil rights laws enforced by https://www.fapiis.gov/ https://www.fapiis.gov/ https://www.fapiis.gov/ http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75

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HHS. See Providers of Health Care and Social Services and HHS Nondiscrimination Notice.

• Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. For guidance on meeting your legal obligation to take reasonable steps to ensure meaningful access to your programs or activities by limited English proficient individuals, see Fact Sheet on the Revised HHS LEP Guidance and Limited English Proficiency.

• For information on your specific legal obligations for serving qualified individuals with disabilities, including reasonable modifications and making services accessible to them, see Discrimination on the Basis of Disability.

• HHS-funded health and education programs must be administered in an environment free of sexual harassment. See Discrimination on the Basis of Sex.https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html

• For guidance on administering your program in compliance with applicable federal religious nondiscrimination laws and applicable federal conscience protection and associated anti-discrimination laws, see Conscience Protections for Health Care Providers and Religious Freedomhttps://www.hhs.gov/conscience/religious-freedom/index.html.

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws or call 1-800-368-1019 or TDD 1-800- 537-7697.

The HRSA Office of Civil Rights, Diversity, and Inclusion (OCRDI) offers technical assistance, individual consultations, trainings, and plain language materials to supplement OCR guidance and assist HRSA recipients in meeting their civil rights obligations. Visit OCRDI’s website to learn more about how federal civil rights laws and accessibility requirements apply to your programs, or contact OCRDI directly at HRSACivilRights@hrsa.gov.

Executive Order on Worker Organizing and Empowerment

Pursuant to the Executive Order on Worker Organizing and Empowerment, HRSA strongly encourages applicants to support worker organizing and collective bargaining and to promote equality of bargaining power between employers and employees. This may include the development of policies and practices that could be used to promote worker power. Applicants can describe their plans and specific activities to promote this activity in the application narrative.

Requirements of Subawards The terms and conditions in the NOA apply directly to the recipient of HRSA funds. The recipient is accountable for the performance of the project, program, or activity; the appropriate expenditure of funds under the award by all parties; and all other obligations of the recipient, as cited in the NOA. In general, the requirements that apply to the recipient, including public policy requirements, also apply to subrecipients under awards, https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html https://www.lep.gov/ http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html…