BHW HRSA-24-074 (T99) MSE finalv3.pdf

HRSA-24-074 MSE i

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Bureau of Health Workforce

Division of Medicine and Dentistry

Medical Student Education Program

Funding Opportunity Number: HRSA-24-074

Funding Opportunity Type(s): New

Assistance Listing Number: 93.680

Application Due Date: July 26, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: June 26, 2024

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: Further Consolidated Appropriations Act, 2024 (P.L. 118-47) mailto:MSENOFO@HRSA.GOV

508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Title: Medical Student Education Program

Funding Opportunity Number: HRSA-24-074

Assistance Listing Number: 93.680

Due Date for Applications: July 26, 2024

Eligible Applicants: Awards are limited to 22 public colleges of medicine in Nevada, Utah, Mississippi, Arizona, Florida, New Jersey, Tennessee, Alabama, Oklahoma, and Idaho.

Anticipated FY 2024 Total Available Funding:

$11,000,000

Estimated Number and Type of Award(s):

3 grants

Estimated Annual Award Amount:

Approximately $1,000,00 per budget year. Three-year grants will be fully funded for a total of $3,666,666 for use over the 2-years and 9-months period of performance.

Not less than $1,000,000 per budget year during each year of the 2-years and 9-months period of performance.

Cost Sharing or Matching Required:

Yes

There is a matching requirement of not more than 10% and not less than 1%.

Period of Performance: September 30, 2024, through June 30, 2027 (2-years and 9-months)

Agency Contacts: Business, administrative, or fiscal issues:

Kim Ross Grants Management Specialist Division of Grants Management Operations, OFAM Health Resources and Services Administration Phone: (301) 443-2353 Email: kross@hrsa.gov Program issues or technical assistance:

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this Notice of Funding Opportunity (NOFO) and in HRSA R&R Application Guide (R&R Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We 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.

mailto:kross@hrsa.gov mailto:MSENOFO@HRSA.GOV https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

ELIGIBLE APPLICANTS I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE:

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR 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 (SWP) Form

vi. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX B: PAGE LIMIT WORKSHEET

HRSA-24-074 MSE 1

I. Program Funding Opportunity Description

1. Purpose:

The purpose of the Medical Student Education (MSE) Program is to provide support to public medical schools in the top quintile of states with a projected primary care physician shortage to expand or support education for medical students preparing to become physicians. This expansion can include funding for direct student supports 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 complete their residency.

Program Goal

The goal of the MSE Program is to increase the number of primary care physicians practicing in states with a projected primary care physician shortage.

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 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.

For more details, see Program Requirements and Expectations.

2. Background

The MSE Program is authorized by the Further Consolidated Appropriations Act, 2024 (P.L. 118-47). A strong primary care system has the capacity to improve population health as well as reduce health disparities.1 While there is a shortage of primary care physicians across the United States, some states are experiencing more dramatic

1 Pham, H, Greiner, A. The Importance Of Primary Care—And Of Measuring It. Health Affairs. (August 2019). Retrieved on April 23, 2024 from https://www.healthaffairs.org/content/forefront/importance-primary-care-and-measuring.

https://www.healthaffairs.org/content/forefront/importance-primary-care-and-measuring https://www.healthaffairs.org/content/forefront/importance-primary-care-and-measuring

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shortfalls that limit access to quality care.2 Maldistribution of the physician workforce is a huge problem that makes it difficult for patients to access the healthcare services they need.3 Therefore, designing medical educational programs to offset physician maldistribution is crucial to ensuring that the distribution of the physician workforce best serves the diverse needs of tribal, rural, and underserved communities.4 Providing training experiences in rural communities to undergraduate and postgraduate medical trainees can influence their practice location decisions.5 In addition, studies have shown that family physicians from a rural background are more likely to choose rural practice than those from an urban background.

The American Indian population is faced with the burden of significant and longstanding disparities in their health and access to health care services.6 In addition to the challenges in accessing health care, they are also challenged by other factors such as geographic isolation, economic issues, and access to culturally appropriate care.7

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.8 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.9

Program Definitions

To better understand this NOFO, go to the dictionary of key program-related terms at Health Workforce Glossary.

The following definitions apply to the MSE Program for the Fiscal Year 2024 NOFO:

2 Hill, L., Artiga, S. Health Coverage Among American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander People Published. (November 30, 2023). Kaiser Family Foundation. Retrieved on April 23, 2024 from https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-among-american-indian-and-alaska-native-and-native-hawaiian-and-other-pacific-islander-people/.

3 Ibid.

4 Ibid 5 Ibid 6 Op.cit. Hill, L., Artiga, S.

7 Elma, A., Nasser, M., Yang, L. et al. Medical education interventions influencing physician distribution into underserved communities: a scoping review. (April 7, 2022). Human Resources for Health. Retrieved April 23.2024 from PubMed https://pubmed.ncbi.nlm.nih.gov/35392954/.

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

8Metz, 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 May 23, 2024 from https://pubmed.ncbi.nlm.nih.gov/28632012/.

9 Ibid.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-among-american-indian-and-alaska-native-and-native-hawaiian-and-other-pacific-islander-people/ https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-among-american-indian-and-alaska-native-and-native-hawaiian-and-other-pacific-islander-people/ https://pubmed.ncbi.nlm.nih.gov/35392954/ https://pubmed.ncbi.nlm.nih.gov/28632012/

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Community-based Organization: a public or private non-profit organization that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety community needs.

Postbaccalaureate Premedical Programs: 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: a 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

Application type(s): New

We will provide funding in the form of a grant.

2. Summary of Funding

We estimate $11,000,000 will be available to fund approximately 3 grants, fully funded at the outset, for use over the 2-years and 9-months period of performance. You may apply for a total not less than $1,000,000 per year for each of the 2-year and 9-months period of performance of the total annual amount of federal funds and no more than $3,666,666 total in federal funding.

The period of performance is September 30, 2024, through June 30, 2027 (2-years and 9-months).

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

Limitations on Indirect Cost Rates for Training and Education Grants:

Indirect costs are those incurred for a common or joint purpose across more than one project and that cannot be easily separated by project (like utilities for a building that supports multiple projects). Learn more at 45 CFR 75.414, Indirect Costs.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/section-75.414

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Indirect costs for training awards cannot exceed 8% of modified total direct costs. To calculate the MTDC, we exclude from the direct cost base:

• Direct cost amounts for equipment, tuition, fees, and other participant support costs

• Subawards and subcontracts exceeding $25,000

To further understand what is included in modified total direct costs, see 45 CFR 75.2.

State or local governments, and federally recognized Indian tribes, receive reimbursement based on their negotiated rate or state cost allocation plans. State universities or hospitals are not considered governmental agencies.

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 physician shortage as determined by the Secretary of the U.S. Department of Health and Human Services.

To determine the eligible states, HRSA used the National Center for Health Workforce Analysis projections through 2036, which indicate there are 43 states with a projected shortage of primary care physicians.10 HRSA ranked states based on their projected levels of primary care physician “adequacy” in 2036.11 The top quintile of 43 states is 8.6 states (rounded up to 9). Idaho and Oklahoma have the same percent adequacy, so both were included, bringing the list to 10 states. Eligible states are Alabama, Arizona, Florida, Idaho, Mississippi, Nevada, New Jersey, Oklahoma, Tennessee, and Utah.

HRSA then identified accredited Osteopathic and Allopathic medical schools in those ten 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 the 22 public, accredited, non-profit colleges of medicine within the ten states that could be eligible for MSE funding. HRSA identified the following accredited public colleges of medicine in these ten states in the

10 Health Resources and Services Administration. Workforce Projections Dashboard. Retrieved on April 3, 2024 from https://data.hrsa.gov/topics/health-workforce/workforce-projections.

11 Percent Adequacy is the relationship between the projected future supply and projected future demand.

It is the quotient of supply divided by demand.

https://www.ecfr.gov/current/title-45/part-75#p-75.2(Modified%20Total%20Direct%20Cost) https://data.hrsa.gov/topics/health-workforce/workforce-projections

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table below.

Public Medical Colleges in Top Quintile of States with a Projected Primary Care Physician Shortage in 203612

State Public Medical School City Alabama University of Alabama School of Medicine* Birmingham

Alabama University of South Alabama College of Medicine* Mobile Arizona University of Arizona College of Medicine – Tucson Tucson Arizona University of Arizona College of Medicine Phoenix Phoenix Florida Charles E. Schmidt College of Medicine at Florida Atlantic

University Boca Raton

Florida Florida International University Herbert Wertheim College of Medicine

Miami

Florida Florida State University College of Medicine Tallahassee Florida University of Central Florida College of Medicine Orlando Florida University of Florida College of Medicine Gainesville Florida University of South Florida College of Medicine Tampa Idaho No public medical school -------------

Mississippi University of Mississippi School of Medicine* Jackson Nevada University of Nevada, Las Vegas School of Medicine Las Vegas Nevada University of Nevada, Reno School of Medicine Reno

New Jersey Cooper Medical School of Rowan University Camden New Jersey Rutgers New Jersey Medical School Newark New Jersey Rutgers Robert Wood Johnson Medical School Piscataway New Jersey Rowan-Virtua School of Osteopathic Medicine Stratford

Oklahoma University of Oklahoma College of Medicine* Oklahoma City Oklahoma Oklahoma State University Center for Health Sciences College of

Osteopathic Medicine* Tulsa

Tennessee East Tennessee State University James H. Quillen College of Medicine

Johnson City

Tennessee University of Tennessee Health Science Center College of Medicine

Memphis

Utah Spencer Fox Eccles School of Medicine at the University of Utah* Salt Lake City

*Please note that any organization already receiving HRSA funding for the MSE Program

12 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 ten listed states and can provide the necessary supporting documentation.

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(HRSA-23-124) is ineligible for funding from this competition.

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.

Native American tribal governments and tribal organizations are not eligible.

All eligible applicants must be accredited. In Attachment 4 the applicant organization must provide:

• a statement that they hold continuing accreditation from the Liaison Committee on Medical Education or American Osteopathic Association and are not under probation, and

• the dates of initial accreditation and next accrediting body review. The full letter of accreditation is not required.

2. Cost Sharing or Matching

Matching is required for this program. We require an amount of not more than ten percent, but not less than one percent matching of the total annual amount of federal funds provided in the grant to each award recipient. 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).

3. Other

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

• Fails to include a budget that reflects the $1,000,000 minimum for each of the 2-years and 9-months period of performance and does not exceed $3,666,666 total grant amount for the 2-years and 9-months period of performance.

• Fails to include accreditation documentation for the applicant organization.

• Fails to satisfy the matching requirement.

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

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Trainee eligibility

To receive support under this program, a trainee must be one of the following:

• A U.S. citizen or non-citizen national;

• 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 institution 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 Unique Entity Identifier (UEI) number will be funded. You may include a request for resources for a branch campus or similar entity as part of their application.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 Research and Related (R&R) workspace application package associated with this NOFO. Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see 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.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-074 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

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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.

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. We 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 do not 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)

• Accreditation Documentation

• Scholarship Chart for Medical Students

• Biographical Sketches

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

If you use an OMB-approved form that is not in the HRSA-24-074 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-074 before the submission deadline.

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals13 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.14

• If you cannot certify this, you must include an explanation in Attachment 9-11:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the R&R Application Guide)

Program Requirements Successful recipients must address the following program requirements.

1. 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 underserved populations.

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

3. Ensure that at least one or more of the clinical sites for medical students are in a primary care setting such as a Teaching Health Center or other community-based setting that provides primary care training.

4. Adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20-12 when evaluating their program.

5. Participate in federally designed evaluations to assess program effectiveness and efficiency upon request.

Optional: Recipients may use grant funds to 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 areas. Postbaccalaureate Premedical Programs are programs that give college graduates the opportunity to complete undergraduate science courses in preparation for application to medical school and other related professional schools, if appropriate.

13 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

14 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 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 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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Program-Specific Instructions Include application requirements and instructions from Section 4 of the R&R Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you’ll find 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 Application Package. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the R&R Application Guide. When applicable, identify if a funding priority/preference is being requested.

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction and Purpose Criterion 1: PURPOSE AND NEED

Organizational Information Criterion 4: ORGANIZATIONAL

INFORMATION, RESOURCES, AND

CAPABILITIES

Need Criterion 1: PURPOSE AND NEED

Approach Criterion 2: RESPONSE TO PROGRAM PURPOSE sub-section (b)

METHODOLOGY/APPROACH

Work Plan Criterion 2: RESPONSE TO PROGRAM PURPOSE sub-section (a) WORK PLAN

Resolution of Challenges Criterion 2: RESPONSE TO PROGRAM PURPOSE sub-section (c) RESOLUTION

OF CHALLENGES

Evaluation and Technical Support Capacity

Criterion 3: IMPACT sub-section (a)

EVALUATIVE MEASURES

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Narrative Section Review Criteria

Sustainability Criterion 3: IMPACT sub-section (b)

SUSTAINABILITY

Budget and Budget Justification Narrative

Criterion 5: SUPPORT REQUESTED

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Project activities must comply with the non-discrimination requirements described in Section VI.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

Introduction and Purpose – Corresponds to Section V’s Review Criterion #1 Purpose and Need

1. Briefly describe the purpose of your proposed project, and the nature of the primary care physician shortages in your state and specifically in tribal, rural, and/or medically underserved areas, and how this grant will address it.

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

Organizational Information– Corresponds to Section V’s Review Criterion #4 Organizational Information/Resources/Capabilities

1. Succinctly describe your organization’s current mission, structure, personnel, organizational partners, and scope of current activities and how these elements all contribute to your organization’s ability to implement the goals, objectives and program requirements.

2. Include a project organizational chart (requested in Section IV.2.v./vi., Attachment 2). Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings.

3. Include in Attachment 3, memorandums of understanding or agreement, and letters of agreement or similar documents from key organizations/individuals of their willingness to perform in accordance with the plan presented in the application.

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4. Include the staffing plan and job descriptions for key faculty/staff in Attachment 1.

o Describe the minimum qualifications for each faculty position in the job description.

o Functional and program responsibilities must be specified in the narrative and position descriptions. A position description should not exceed one page in length but can be as short as one paragraph in length due to page limits.

Biographical Sketches

Provide a biographical sketch for key faculty/staff contributing to the project. Include the individual’s current position and sufficient detail to assess their qualifications for the position. Each biographical sketch should be limited to two pages. 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

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

Need – Corresponds to Section V’s Review Criterion #1 Purpose and Need

1. Describe the 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.

2. Describe 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. This section will help reviewers understand whom you will serve with the proposed project. Use and cite demographic data whenever possible to support the information provided.

Approach – Corresponds to Section V’s Review Criterion #2 Response to Program Purpose sub-section (b) Methodology/Approach

In your application, and consistent with the Program Requirements in this NOFO:

1. List the project objectives and proposed activities and provide evidence for how they link to the project purpose and needs. These are the same project objectives in the Standardized Work Plan (SWP).

2. Describe strategies used to 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.

3. Discuss how you will provide scholarships for medical students to encourage applications to a primary care residency program (general internal medicine, general pediatrics, family medicine, or med/peds).

4. Describe 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.

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5. Explain your strategies to improve medical students’ cultural competence to meet the needs of underserved communities and increase the use of culturally and linguistically appropriate services by providing training based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

6. Provide a table description of the primary care clinical sites for medical students such as in a Teaching Health Center or other community-based setting in Attachment 5. Include the name of the primary care site and number of medical students for each year of the award. A sample is provided below.

Table 1: Primary Care Clinical Sites

Name of Clinic Rotation Site

Clinic Training Site Full Address

(EXAMPLE

Main Street, Town, State, Extended Zip code)

Tribal Site (Yes/No)

Is site located in rural area as determined by the Federal Office of Rural Health Policy (FORHP), using the Rural Health Grants Eligibility Analyzer at https://data.hrsa.gov/t ools/rural-heal (Yes or No)

Number of students who will be involved in grant activities per year.

Grant Year 1,2,3

Optional Activity: Describe strategies you will use in developing or enhancing your Postbaccalaureate Premedical Programs that support the transition from undergraduate to medical school.

Work Plan – Corresponds to Section V’s Review Criterion #2 Response to Program Purpose sub-section (a) Work Plan

1. Describe the activities or steps you will use to achieve the goal and each of the 3 program objectives during the entire 2-years and 9-months period of performance.

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

3. Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities. Include the extent to https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health

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which these contributors address the needs of the population(s) being served in the primary care clinical sites.

4. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented and appropriately used.

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 SWP Form located in the Grants.gov workspace. Include a brief narrative element as outlined, in addition to completing the SWP Form.

The SWP 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 Goals section of the SWP Form. For example, Goal 1 in the Purpose section of the NOFO will need to be entered as Goal 1 in the SWP Form. The objectives must be those of this NOFO which can be found on page 1. Sub-objectives can be tailored to your project needs. Sub-objectives may be tagged with organizational priorities by selecting applicable priorities on the SWP Form. For the purpose of this NOFO, please write in “Health Equity” in the “Other Priority Linkage” if your sub-objectives align with this priority. Form instructions are provided along with the SWP Form and are included in the application package found on Grants.gov. The Project Director must register in the HRSA Electronic Handbooks (EHBs) once an award is made, in order to review and finalize the completed SWP Form.

Resolution of Challenges – Corresponds to Section V’s Review Criterion #2(c) Response to Program Purpose subsection (c) Resolution of Challenges In your application:

1. Discuss challenges that you are likely to encounter in designing and implementing the goal and three program objectives including providing scholarships to medical students, curricula development, and rotation of medical students in primary care community-based sites.

2. If applicable, discuss challenges that you are likely to encounter in developing or enhancing your Postbaccalaureate Premedical Programs that support the transition from undergraduate to medical school.

3. Discuss the approaches you will use to resolve the challenges described above.

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Evaluation and Technical Support Capacity – Corresponds to Section V’s Review Criterion #3(a) sub-section (a) Evaluation and Technical Support Capacity

In your application:

1. Describe your organizational profile, budget, partners, key personnel’s experience, skills, and knowledge, key processes, and expected outcomes of the funded activities.

2. Describe the systems and processes that you’ll use to track performance outcomes. Describe how you’ll collect, report, manage, and securely store data (for example, assigned skilled staff, data management software) in a way that allows for accurate and timely reporting of those outcomes. At the following link you’ll find examples of the current required reporting forms required for this grant program: Report on your Grant. Note: Performance measures and data forms are subject to change each academic year.

3. Document the procedure for assuring the data collection, management, storage, and reporting for eligible individuals participating in the MSE Program, as well as a process to track and collect data, including the collection of National Provider Identifier (NPI) numbers, on trainees after program completion/graduation for up to 1 year. (Note: Trainees in eligible professions/disciplines who receive HRSA funds as a result of this award are required to apply for an NPI for the purpose of collecting post-graduation employment demographics).

4. Describe your 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. Include descriptions of evaluation questions, methods, data to be collected, and timeline for implementation. Include descriptions of the inputs (for example, organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, variables to be measured, and expected outcomes of the funded activities. Evaluations must adhere to HHS Evaluation Policy and evaluation standards and best practices described in OMB Memorandum M-20-12.

5. Describe the evaluation capacity of your organization and staff. Include current experience, skills, and knowledge, along with individuals on staff, materials published, and previous evaluation work. Describe any potential obstacles for implementing the program OMB Memorandum M-20-12 performance evaluation and meeting our performance measurement requirements and your plan to address those obstacles. The evaluation and https://bhw.hrsa.gov/funding/report-on-your-grant 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 https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf

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reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which project activities are replicable.

Sustainability – Corresponds to Section V’s Review Criterion #3(b) Impact sub-section (b) Project Sustainability

1. Include a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding; and (c) provide a timetable for becoming self-sufficient.

2. Propose a project sustainability plan for when the period of federal funding ends that addresses how your program will continue.

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

iii. Budget

Budget - Corresponds to Section V’s Review Criterion #5 Support Requested

The R&R Application Guide directions may differ from those on Grants.gov.

Follow the instructions in Section 4.1.iv Budget of the R&R Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs used for the HRSA activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include Maintenance of Effort (MOE), if applicable).

Subawards/subcontracts

Upload a detailed line-item budget form for each subaward to the Subaward Budget Attachment(s) Form. NOTE: 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 (such as back-up information) are included in the page limit.

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Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR § 75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

Specific Instructions

• The budget amount for each year of the 2-years and 9-months period of performance must not be less than $1,000,000.

iv. Budget Justification Narrative

Budget - Corresponds to Section V’s Review Criterion #5 Support Requested

See Section 4.1.v. of the SF-424 R&R Application Guide.

Use of Funds If applicable, applicants must provide information about the following in the budget,

• Number and amount of scholarships for medical students;

• 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.

o Infrastructure development – for this NOFO means sufficient personnel, financial resources, 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 allowable cost. See definitions 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.

• Describe all line-item federal funds (including subawards), proposed for this project. Please note: all budget justification narratives count against the page limit.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=35 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=35

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• Provide justification for all line-items for each of the three budget years of your program and provide a brief summary describing total direct and indirect costs annually and across all three budget years of the project.

If you include participant or trainee support costs:

• List tuition, fees, health insurance, travel, and other costs.

• Identify the number of participants and trainees.

• Separate these costs from others so we can identify them easily.

• Include a sub-total entitled “Total Participant and Trainee Support Costs” with the summary of these 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.

v. Standardized Work Plan (SWP) Form

As part of the application package submitted through Grants.gov, you must complete and electronically submit the SWP 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 attachments in the order we list them.

Most attachments count toward the application page limit. Indirect cost rate agreement, proof of non-profit status (if it applies), biographical sketches, accreditation documents and Scholarship Chart for Medical Students are the exceptions. They will not count toward the page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to.

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

Keep each job description to two pages in length as much as 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 personnel costs.

Attachment 2: Project Organizational Chart - required

Provide a one-page figure that depicts the organizational structure of the project (not the applicant organization).

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Attachment 3: Letters of Agreement, Memoranda of Understanding, and/or Contracts – required

Provide any documents that describe working relationships with…