HRSA_22-107.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Teaching Health Center Planning and Development Program

Funding Opportunity Number: HRSA-22-107

Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.530

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: August 30, 2021

SAM.gov and Grants.gov administrative flexibilities have been implemented.

Please see Section IV.3 for more information.

Issuance Date: July 14, 2021

LCDR Tonya Twyman Project Officer, Division of Medicine and Dentistry Bureau of Health Workforce, HRSA Telephone: (301) 443-6535 Email: TTwyman@hrsa.gov

Authority: Section 749A of the Public Health Service Act (42 U.S.C.293l-1) and Section 2604 of the American Rescue Plan Act of 2021 (P.L.117-2).

mailto:TTwyman@hrsa.gov

HRSA-22-107

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Teaching Health Center Planning and Development (THCPD) Program. The purpose of this program is to make awards to establish new accredited or expanded community-based primary care residency programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, or geriatrics to support the expansion of the primary care physician and dental workforce in underserved communities.

The THCPD program aims to support the expansion of primary care residency training in community-based patient care settings by providing funds to support the development of new programs in these settings, which are often located in underserved areas where resources may not easily attainable. As such, THCPD funding may be utilized to support the development of new residency programs only.

The new community-based residency programs will: (1) achieve accreditation through the Accreditation Council for Graduate Medical Education (ACGME) or the American Dental Association’s Commission on Dental Accreditation (CODA), (2) ensure a sustainability plan through public or private funding beyond the THCPD period of performance, and (3) track residents’ career outcomes post-graduation, including but not limited to retention in rural and/or underserved communities.

Funds will support planning and development costs accrued while achieving program accreditation. Community-based ambulatory patient care centers are eligible to apply for a grant award.

Funding Opportunity Title: Teaching Health Center Planning and Development Program

Funding Opportunity Number: HRSA-22-107 Due Date for Applications: August 30, 2021 Anticipated Total Annual Available FY 2021 Funding:

$25,000,000

Estimated Number and Type of Awards:

Up to 50 grants

Estimated Award Amount: Up to $500,000 fully funded in Year 1 for the 2-year period of performance

Cost Sharing/Match Required: No Period of Performance: December 1, 2021 through November 30, 2023

(2 years) Eligible Applicants: Eligible applicants are community-based ambulatory patient care centers which include, but are not limited to:

• Federally qualified health centers;

• Community mental health centers;

• Rural health clinics;

• Health centers operated by the Indian

Health Service, an Indian tribe or tribal organization, or an urban Indian organization; or

• An entity receiving funds under Title X of the PHS Act.

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in 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/

HRSA-22-107

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

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

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

REQUIREMENTS OF SUBAWARDS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Teaching Health Center Planning and Development (THCPD) Program.

Program Purpose The purpose of this grant program is to support the development of new accredited primary care residency programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, and geriatrics to address the physician workforce shortages and challenges faced by rural and underserved communities.

Teaching Health Center primary care residency programs are accredited medical and dental residency training programs that train residents in community-based training sites and focus on producing physicians and dentists who will practice in underserved communities. For example, one residency training model is the 1+2 Rural Training Track (RTT), where the first year of training occurs within a larger community-based facility such as a federally qualified health center (FQHC), and the final two years in a rural health community-based setting.

This program aims to support the expansion of primary care residency training in community-based patient care settings by providing funds to support the development of new programs in these settings, which are often located in underserved areas where resources may not easily attainable. As such, THCPD funding may be utilized to support the development of new residency programs only; applications from existing residency programs (i.e. those already training residents) will not be considered.

Programs wishing to expand primary care training in their residency program should submit an application for resident full-time equivalent (FTE) support through the Teaching Health Center Graduate Medical Education (THCGME) Program, announcement HRSA-22-105.

Program Goal The goal for the THCPD program is for each recipient to establish a new community-based residency program that is accredited by the Accreditation Council on Graduate Medical Education (ACGME) or the American Dental Association’s Commission on Dental Accreditation (CODA) and has a strong sustainability plan for a stable future financial outlook by the end of the period of performance. All THCPD program recipients should be capable of effectively training physicians and/or dentists to practice in and meet the clinical needs of underserved populations. As a result, the proportion of graduates from these programs entering careers in practices primarily serving rural and underserved populations is expected to markedly exceed that seen in other residency training programs.

Funds provided through the THCPD program may be used to support the costs of establishing a community-based residency program. This includes costs associated with curriculum development; recruitment, training and retention of residents and faculty;

resident stipends (after accreditation has been achieved), for a period of up to one year during the 2-year period of performance; accreditation by the ACGME or CODA; and faculty salaries during the development phase.

Program Objectives

1) Residency Program Development – develop a new accredited community-based residency program in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, or geriatrics that is ready to begin training its first class of residents no later than the academic year (AY) immediately following the end of the THCPD period of performance. In addition, programs should:

A. Provide interprofessional training specific to the needs of their community which may include training with behavioral health professionals and paraprofessionals, nutrition specialists and pharmacists;

B. Aim to decrease health care disparities by identifying and immersing trainees in the care of special populations that will be served by the training program such as members of tribal communities, veterans, people living with HIV, patients who are uninsured or underinsured, patients with substance use disorder, or other populations served by HRSA programs; and

C. Address other known challenges specific to Teaching Health Center residency programs including, but not limited to, having sufficient specialty and subspecialty preceptors and ensuring residents will encounter a high enough volume of patients.

2) Program Sustainability – have a clearly defined, factual, and validated sustainability plan that includes ongoing funding stream(s) to sustain long-term resident training once the program is established through the following options:

A. State or other public and/or private support B. Combination of multiple funding streams (e.g., a mix of Department of

Veterans Affairs, Indian Health Service, or other public funding)

Refer to Section IV.2.ii Project Sustainability for further details.

2. Background

This program is authorized by Section 749A of the Public Health Service Act (42 U.S.C.

293l-1) and funded by Section 2604 of the American Rescue Plan Act of 2021 (P.L.

117-2).

The National Center for Health Workforce Analysis (NCHWA) projects that the total demand for primary care physicians will grow by 38,320 FTEs between 2013 and 2025.

Estimates project that there will be a shortage of 23,640 primary care physician FTEs by

2025.1 The NCHWA also notes that the demand for dentists is projected to grow by

1 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA.

“National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025”.

20,400 FTEs – from 197,800 in 2012 to 218,200 in 2025 - a 10 percent increase in need. Moreover, all 50 states and the District of Columbia are projected to experience a shortage of dentists.2 In addition to overall shortages, there is maldistribution of primary care providers, with rural and other underserved communities experiencing the greatest shortages.

Approximately 18 percent of the population, roughly 57 million individuals, live in rural communities.3 Of the nearly 2,000 rural counties in the United States, 1,895 (95 percent) are entirely or partially in primary care health professional shortage areas (HPSAs).4 However, higher primary care physician densities in rural areas correlate with increased quality of care and reduced rates of hospitalization for certain conditions.5 Rural areas also often lack access to behavioral health providers that they critically need - 80 percent of non-core rural counties (i.e. those that lack an urban core) do not have a psychiatrist.6 Enrolling trainees with rural backgrounds and training residents in rural settings are strategies shown to successfully encourage graduates to practice in rural settings.7

The Medicare Payment Advisory Commission (MedPAC) and other stakeholders have called for increasing the amount of Graduate Medical Education (GME) time spent in nonhospital settings, making changes to GME funding to advance goals such as increasing community-based care, and increasing the diversity of the pipeline of health professionals.8 However, community-based ambulatory residency programs often face unique challenges and barriers not experienced by their traditional hospital-based counterparts. Common challenges often include a lack of sufficient community-based specialty and subspecialty preceptors willing to sponsor residents for educational/clinical rotations, and ensuring residents will encounter a sufficient patient volume to meet accreditation requirements. Section 749A of the PHS Act addresses these needs by authorizing development grants to cover the cost of establishing accredited primary care residency programs in community-based settings. The THCPD program provides funding to support including costs associated with curriculum

November 2016. Available at: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf.

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA.

“National and State-Level Projections of Dentists and Dental Hygienists in the U.S., 2012-2025”. February 2015. Available at:

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nationalstatelevelprojectionsdentists.pdf.

3 HRSA Federal Office of Rural Health Policy: https://www.hrsa.gov/rural-health/about-us/definition/index.html.

4 Department of Health and Human Services, Health Resources and Services Administration Data Warehouse, October 2019.

5 Alex McEllistrem-Evenson. Informing Rural Primary Care Workforce Policy: What Does the Evidence Tell Us?: A Review of Rural Health Research Center Literature, 2000-2010. April 2011. Available at:

https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a.

6 Larson EH, Patterson DG, Garberson LA, Andrilla CHA. Supply and Distribution of the Behavioral Health Workforce in Rural America. Data Brief #160. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, Sep 2016. Available at: https://www.ruralhealthresearch.org/publications/1058.

7 Rosenthal TC, McGuigan MH, Anderson G. Rural residency tracks in family practice: graduate outcomes.

Fam Med. 2000;32:174 –7.

8 Report to the Congress: Aligning Incentives in Medicare (June 2010). Medicare Payment Advisory Commission. (Available at http://www.medpac.gov).

https://www.hrsa.gov/rural-health/about-us/definition/index.html https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a https://www.ruralhealthresearch.org/publications/1058 development, recruitment, training and retention of residents and faculty, accreditation, and faculty salaries during the development phase of the eligible residency programs.

Supporting the development of new community-based ambulatory residency programs will have a direct impact on increasing healthcare providers in rural and underserved areas. It is part of the Administration’s commitment to addressing longstanding health inequities and expanding the pipeline of health care providers serving rural and underserved communities.

Findings from HRSA’s Teaching Health Center Graduate Medical Education (THCGME) program (authorized by Section 340H of the PHS Act), which provides payments to support primary care medical and dental residency training in community-based ambulatory outpatient care settings, demonstrate the increased likelihood that residents who train in health center settings are more likely to practice in underserved settings after graduation. Since the program began in FY 2010, the THCGME Program has graduated 1,434 new primary care physicians and dentists. Cumulative follow-up data indicates that 65 percent of THCGME-funded graduates are currently practicing in a primary care setting and approximately 56 percent of the THCGME-funded graduating physicians and dentists are currently practicing in a medically underserved community and/or rural setting.9

While the THCPD program provides funds to establish new primary care residency programs in community-based ambulatory patient care settings, THCGME payment program funds are made available through a separate authorization and appropriation, as noted above.

In addition, to support THCPD award recipients, HRSA will fund a Teaching Health Center Planning and Development Technical Assistance (THCPD-TA) program (HRSA- 22-108). The THCPD-TA awardee will work with THCPD program awardees to share resources. All THCPD awardees are required to collaborate with the TA program during the period of performance of this NOFO.

Program Definitions A glossary containing general definitions for terms used throughout the Bureau of Health Workforce can be located at the Health Workforce Glossary. In addition, the following definitions apply to the THCPD Program for Fiscal Year 2022:

1) Approved graduate medical residency training program – 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.

9 Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. THCGME Program Academic Year 2019-2020 Highlights. Available at:

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/thcgme-outcomes-2019-2020.pdf.

https://bhw.hrsa.gov/glossary

2) Area Health Education Center (AHEC) Program– As defined in Title VII, Section 799B(13) of the PHS Act [42 U.S.C. § 295p(13)], the term ‘‘area health education center program’’ means cooperative program consisting of an entity that has received an award under subsection (a)(1) or (a)(2) of section 751 [42 U.S.C. § 294a] for the purpose of planning, developing, operating, and evaluating an area health education center program and one or more area health education centers, which carries out the required activities described in section 751(c) [42 U.S.C. §294a(c)], satisfies the program requirements in such section, has as one of its principal functions identifying and implementing strategies and activities that address health care workforce needs in its service area, in coordination with the local workforce investment boards.

3) Graduate Medical Education Consortium – 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 faculty, support 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.

4) National Provider Identifier (NPI) – The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The NPI is a unique identification number for covered health care providers. Additional information about NPIs can be found at the following site: https://nppes.cms.hhs.gov/#/.

5) Primary care residency program - As defined in section 749A(f)(2) of the PHS

Act [42 U.S.C. §293l-1(f)(2)], an approved graduate medical residency training program (as defined in section 340H) in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, and geriatrics.

6) Rural Training Tracks (RTT) – a rural residency program model that consists of partnerships between urban and rural clinical settings where the first year of training occurs within a larger community-based program such as a FQHC, and the final two years occur in a rural health community-based setting.

7) Teaching Health Center (THC) – As defined by 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 https://nppes.cms.hhs.gov/

Service (IHS), by tribes or tribal organizations, or by urban Indian organizations;

and, entities receiving funds under Title X of the PHS Act

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $25,000,000 to be available to fund up to 50 recipients.

You may apply for a ceiling amount of up to $500,000 total cost (includes both direct costs and indirect costs, facilities and administrative costs) for the entire 2-year period of performance. The period of performance is December 1, 2021 through November 30, 2023 (2 years). Awards are fully funded at the outset for use over the period of performance.

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

III. Eligibility Information

1. Eligible Applicants

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

A. Eligible Entities

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

i. Will operate 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)];

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 http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 defined in section 4 of the Indian Health Care Improvement Act [25 U.S.C. 1603]); and

An 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 community-based settings such as those served by the institutions listed.

OR

ii. Has collaborated to form a community-based GME consortium that will operate an accredited primary care residency program.

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

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

B. Eligible Primary Care Residency Programs

Only specific residency training programs are eligible. According to statute (section 749A(f)(2) of the PHS Act [42 U.S.C.293l-1(f)(2)]), “primary care residency program” refers to a graduate medical or dental education residency training program in:

• Family Medicine

• Internal Medicine

• Pediatrics

• Internal Medicine-pediatrics

• Obstetrics and Gynecology

• Psychiatry

• General Dentistry

• Pediatric Dentistry

• Geriatrics

C. Accreditation/Institutional Sponsorship

The eligible community-based ambulatory patient care setting or GME consortium must propose to develop a new accredited residency program in one of the eligible primary care specialties. Once accreditation is achieved, the eligible community-based ambulatory patient care setting or GME consortium must be listed as the institutional sponsor by the relevant accrediting body (i.e. ACGME or CODA) and named on the program’s accreditation documentation.

Programs receiving THCPD support should be ready to begin training their first class of residents no later than the academic year (AY) immediately following the end of the THCPD period of performance.

Non-community-based ambulatory patient care settings such as teaching hospitals, health care systems and/or networks, and academic institutions are not eligible to receive THCPD funding. Applications requesting funding to expand training at an existing residency program are not eligible. Entities that have achieved ACGME accreditation for a residency program in the above specialties by the application closing date are not eligible.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $500,000 total costs (includes both direct costs and indirect, facilities and administrative costs) for the full period of performance non-responsive and will not consider it for funding under this notice.

Page Limit HRSA will consider any application that exceeds the page limit referenced in Section IV.2 non-responsive and will not consider it for funding under this notice.

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.

Multiple Applications NOTE: Multiple applications from an organization are allowable. Entities seeking THCPD funding to support multiple new residency programs MUST submit a separate application for each individual residency program. If an entity is submitting multiple applications for different residency programs, please include a unique name for each training program in the project abstract to differentiate between applications.

Applications requesting funding to expand training at an existing residency program are not eligible. Applications from existing Teaching Health Center Graduate Medical Education (THCGME) recipients requesting funding to expand training in a THCGME-funded residency program will not be considered. However, applications from existing THCGME recipients applying for THCPD funding to develop a new, non-THCGME supported residency program are allowable (e.g., a THC receiving THCGME support for a Family Medicine program may apply for THCPD to support the development of a new program in Pediatrics at the THC).

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.

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

Program Sustainability Applications must have a clearly defined, factual, and validated sustainability plan that includes ongoing funding stream(s) to sustain resident training once the program is established. See Section IV.2.ii. Program Sustainability for more information on sustainability options.

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.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

2. Content and Form of Application Submission Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-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 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit shall not exceed the equivalent of 65 pages when printed by HRSA. The page limit includes the project and budget narratives, attachments, and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form "Project Abstract Summary.” Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Biographical sketches do count in the page limitation. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22- 107, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 65 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

3) Where you are unable to attest to the statements in this certification, an explanation shall be included 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-Specific Instructions

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

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 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf attachment. For information content required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide .

In addition to the SF-424 R&R Application Guide requirements, the project abstract must include the following information below. The project abstract must be single-spaced and no more than one page in length.

Abstract Heading Content:

a. 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 will operate the residency program alone or as part of a GME consortium

b. Project Director Contact Information

c. Proposed Residency Type (e.g. Family Medicine residency)

d. Funding preference statement (if applicable)

e. Population Target Area(s)

f. Funding Amount Requested (total for the two-year project period)

g. Projected Number of Residents in the Program; and

h. Expected ACGME or CODA Accreditation and Residency Matriculation

Dates Abstract Body Content:

Brief overview of the project. This includes a description of the geographic area and target patient population and needs. Also include consortium partners (if applicable); clinical partnerships (e.g., affiliated hospitals, clinical sites, Veteran Affairs clinical sites); specific measurable objectives;

expected outcomes of the project; and how the proposed project for which funding is requested will be accomplished (i.e., the "who, what, when, where, why and how" of a project).

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

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

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

“Purpose and Need”

Briefly describe the purpose of the proposed project and clearly identify specific project goals, objectives, and expected outcomes. Summarize how the proposed project will address the health needs of the community, and how the expansion of family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry or geriatrics will increase access for the proposed target area(s).

Provide an overview of the health workforce and health care needs of the target area(s) served by the proposed project. This section should primarily focus on describing the needs of the community, the organization and facility(s) needs to develop a new community-based residency program, and an assessment of the current health care infrastructure, including the graduate medical education landscape and other residency programs serving the community. You must use and cite demographic data (e.g., local, state, federal) whenever possible to support the information provided.

Specifically, this section must include the following information:

1) Description of the geographic area in which the residency program will be located and the justification for why this geographic area was selected to develop a new residency program. To the extent possible, include data on the population demographics, social determinants of health, health disparities faced by, and health care needs of, the population served, barriers to access and care, and any other unmet needs. Indicate the presence of Medically Underserved Communities (MUC) and/or Health Professional Shortage Areas (HPSA).

2) Description of any special populations served by the training program and that trainees are immersed in the care of, such as members of tribal communities, Veterans, people living with HIV, patients who are un/under insured, patients with substance use disorder, or other groups served by HRSA programs and describe plans to decrease health care disparities.

3) Shortages and need for additional physicians in the specialty for which you are applying for funding, including current (within 3 years) information and data demonstrating needs for the proposed specialty in the target area(s) and identify specific reasons for this shortage.

4) Description of the health care delivery system and the specific needs of the facility(s) hosting the residency program. Include information on the organization’s structure and the clinical and faculty capacity needed to support a new residency program.

5) Description of any residency programs (existing or in development) in the specialty area for which you are applying for funding, that serves the target area(s) where the proposed new residency program will be located.

6) Description of any progress that has already been made towards developing a residency program.

7) Characteristics of existing residency program partners that align with the purposes of this project and need for strengthening of academic and community linkages/partnerships with private sector or safety net providers for development of clinical training sites for residents, preceptor development and retention, and well-trained, culturally competent health care providers.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections — (a) Methodology/Approach; (b)Work Plan, and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review

Criterion #2(a)

Propose methods that will be used to address the stated needs and how they will achieve identified program goals and objectives. Clearly specify how the proposed methods will overcome challenges and barriers identified in the “Needs Assessment” section above. Specifically, this section must include how you plan to achieve:

1) ACGME or CODA accreditation for the new residency program by no later than the end of the program performance period (i.e., November 30, 2023). Applicants must describe:

a. Clinical capacity to meet ACGME or CODA accreditation requirements including sufficient numbers of dedicated, supervisory faculty, adequate patient care volume, and appropriate resident training time in relevant medical specialties and subspecialties. Note: This may be achieved through clinical training partnerships. In this case, Letters of Agreement must be submitted in Attachment 3.

b. Current organizational structure and plan to meet ACGME or CODA requirements, including governance structure and the capacity of the organization to meet ACGME or CODA sponsoring institution requirements. This may also include acquiring access to electronic health records, library services, learning management systems, etc.

c. Faculty recruitment and development plan to support the residency program , including recruiting specialty faculty to meet ACGME or CODA requirements for the proposed specialty.

d. Curriculum and training plan, including incorporation of interprofessional training and development, culturally and linguistically appropriate care, and training to address the health needs and disparities of patients from the proposed target area(s). The curriculum plan should be high quality, leading to successful board certification of graduates and readiness for clinical practice following completion of training.

2) Resident matriculation no later than the AY immediately following the end of the program period of performance (i.e. July 1, 2024).

Applicant must describe a plan to:

a. Recruit and support a diverse cohort of high quality residents, including outreach to medical students with rural and disadvantaged backgrounds.

b. Recruit and train at least the minimum number of residents required to achieve and maintain accreditation for the proposed specialty.

c. Promote retention of resident graduates to practice in underserved and rural communities.

3) Tracking residents’ career outcomes for a period of at least 5 years post- graduation from the residency program. Applicants must describe a plan to:

a. Develop a tracking tool/mechanism or leverage an existing graduate tracking system to track and publicly report on graduates’ career outcomes and retention in rural and underserved areas, including but not limited to, practice specialty/sub-specialty and location. At a minimum, the graduate tracking plan should be equipped with the ability to accurately collect the following graduate measures:

i. National Provider Identifier (NPI)

ii. Practice location(s)

iii. Specialty Area

iv. Part-time or full-time practice status

b. Track other practice characteristics and graduates’ demographics.

Note: Award recipients should consider adding the performance measures related to accredited positions, admissions, and enrollees by year of training, by age, gender, race, ethnicity, location of training, new curriculum development, and faculty development and intent to be employed in underserved or rural areas, to the plan for tracking characteristics of practice and graduates. Award recipients that initiate their programs during the period of performance will be required to report on selected characteristics of enrollees and graduates. Refer to https://bhw.hrsa.gov/grants/reportonyourgrant for examples of performance data.

Additionally, applicants should include innovative approaches or any unique characteristics of the program that would enhance the quality of residency training and address the stated needs of the targeted area(s), such as:

• Emerging patient-centered care or health care delivery strategies (e.g., patient- centered medical homes, telehealth etc.)

• Integration of interprofessional education and practice

• Integration of culturally and linguistically competent care

• Integration of oral health and/or mental health and substance use disorder treatment

• Plans to incorporate pandemic response into resident training models https://bhw.hrsa.gov/grants/reportonyourgrant

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

Provide a clear and coherent work plan describing the process to achieve each of the program goals/objectives in Attachment 1. A sample work plan can be found at http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.

The work plan must clearly:

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

2) Describe the timeframes and deliverables, and identify key faculty, staff and partners responsible for executing on each activity during the THCPD award period of performance;

3) Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation;

4) Identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the populations and communities served; and

5) Explain, if funds will be sub-awarded or expended on contracts, how your organization will ensure these funds are properly used and monitored, including having policies and procedures in place that meet or exceed the requirements in 45 CFR part 75 regarding sub-recipient monitoring and management.

Note: A complete staffing plan and job descriptions for key personnel must be submitted in Attachment 2. Letters of Agreement for key stakeholders involved in the work plan must be submitted in Attachment 3 and/or Attachment 6 (related to program sustainability).

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

Review Criterion #2(c)

Discuss barriers and challenges likely to be encountered planning and developing a new community-based residency program. Specifically, applicants must address the following:

1) Highlight any roadblocks you are likely to encounter in implementing activities described in the work plan and approaches that you will use to resolve these challenges.

2) Describe any additional challenges both internal and external to your organization, including key stakeholders (e.g. sponsoring institution, clinical training sites, etc.), that may directly or indirectly affect development of the program. Discuss how these challenges will be resolved.

3) Describe challenges and resolutions to incorporating http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx interprofessional health care, culturally and linguistically competent health care and innovative approaches to achieve health equity, and recruiting a diverse cohort of high quality residents.

4) Address other known challenges specific to community-based residency programs such as having sufficient specialty and subspecialty preceptors and ensuring residents will encounter a high enough volume of patients.

IMPACT -- This section includes two sub-sections— (a) Evaluation and

Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY --

Corresponds to Section V’s Review Criterion #3(a)

Describe the plan for program performance evaluation that will meet ACGME or CODA accreditation requirements and promote continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities.

Describe the systems and processes that will support your organization's performance management requirements through effective tracking of performance outcomes. You must describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

Prior to the end of the period of performance, grant recipients must report on the following outputs. Please provide anticipated values for these outputs in your application:

Number and type (i.e., model and specialty) of newly established residency programs Number of residents each residency program will support once fully established (longer-term goal) Number and type of existing clinical training sites for residents Number and type of newly established clinical training sites for residents Number of faculty and staff trained to teach, support and administer the curriculum at each residency program Number and type of existing partnerships (e.g., non-clinical training site) that support the residency program Number and type of newly established partnerships (e.g., non-clinical training site) that support the residency program

By the end of the period of performance, award recipients will be required to submit:

Documentation of ACGME or CODA accreditation status and plans for future accreditation review and status maintenance;

Detailed professional certification, training profile, and planned time dedicated to residency supervision and training of residency program leadership (e.g. Program Directors/Associate and Assistant Program Directors) and Key Clinical Faculty, in line with the current ACGME or CODA accreditation requirements for these positions.

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

Criterion #3(b)

Applicants must propose a clearly defined, fact-based, validated sustainability plan to support the long-term financial sustainability for the new residency program beyond the THCPD period of performance. Health care sites sponsoring new residency programs through this grant program must additionally have a strong, long-term outlook in regard to their financial stability. The application must speak at least broadly to this institutional financial outlook.

The application must clearly describe a financial sustainability plan for supporting the costs of the eligible residency program, including financial investments you have already made, any foreseeable challenges and barriers to your…