HRSA-24-019 (T8R) PCTE PARB.pdf

Bureau of Health Workforce | Division of Medicine and Dentistry

Opportunity Number: HRSA-24-019

Primary Care Training and Enhancement:

Physician Assistant Rural Training in Behavioral Health (PCTE-PARB) Program

Contents Before You Begin

Step 1: Review the Opportunity 2

Basic Information Eligibility Program Description

Step 2: Get Ready to Apply 9

Get Registered Find the Application Package Application Writing Help

Step 3: Write Your Application 11

Application Contents & Format

Step 4: Learn About Review & Award 23

Initial Review Merit Review Risk Review Selection Process Award Notices

Step 5: Submit Your Application 31

Deadline Submission Method Other Submissions Application Checklist

Learn What Happens After Award 34

Administrative & National Policy Requirements Reporting Non-Discrimination & Assurance

Contacts & Support 37

Agency Contacts Grants.gov SAM.gov Helpful Websites Endnotes

Before You Begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registration is active and up-to-date.

SAM.gov Registration (this can take several

WEEKS)

You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov Registration (this can take several

DAYS)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by March 15, 2024

Applications are due by 11:59pm Eastern Time on March 15, 2024.

https://sam.gov/content/home https://grants.gov/

Step 1: Review the Opportunity Basic Information 3

Eligibility 4

Program Description 5

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Step 1: Review the Opportunity

Step 2: Get Ready to Apply

Step 3: Write Your Application

Step 4: Learn About Review & Award

Step 5: Submit Your Application

1. The Opportunity 2. Get Ready 3. Write 4. Review & Award 5. Submit

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 Agency Contacts.

Basic Information The Key Facts

Opportunity Name: Primary Care Training and Enhancement: Physician Assistant Rural Training in Behavioral Health (PCTE-PARB) Program

Opportunity Number: HRSA-24-019

Federal Assistance Listing Number: 93.884

Statutory Authority: The PCTE-PARB program is authorized by Title VII, Section 747(a)(1)(F) of the Public Health Service (PHS) Act (42 U.S.C. § 293k(a)(1)(F)).

Improve rural access to physician assistant support for behavioral health needs.

Summary This program addresses the need to train primary care physician assistants to prevent, identify, diagnose, treat, and refer services for behavioral health conditions. Our goal is to increase the number of trained physician assistants who choose to practice in rural areas after graduation. To do this, applicants must meet the following program objectives:

• A 3-month minimum integrated behavioral health clinical rotation(s) in a rural primary care setting(s).

• Develop program curriculum to address behavioral health and substance use disorders.

• Establish strategic partnerships that support primary care behavioral health integration in rural areas.

Have questions?

Go to Contacts & Support.

Key Dates Application Deadline: March 15, 2024

NOFO issue date: December 14, 2024

Expected award date: July 1, 2024

Expected start date: July 1, 2024

Funding Detail Application Type: New

Expected total funding in FY 2024: $5,000,000

Expected awards: 12 new grants

Funding range per award in FY 2024: Up to $415,000

HRSA plans to fund awards in five 12-month budget periods for a total five-year period of performance from July 1, 2024, through June 30, 2029.

All awards and amounts depend on receiving appropriations.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can return to where you were by pressing Alt + the back arrow.

Eligibility Who Can Apply

Eligible Applicants Only an academically affiliated physician assistant training program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) may apply.

To be eligible, your organization must be in the United States, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau.

Other Eligibility Criteria You must provide documentation of your ARC-PA accreditation as Attachment 1. Please do not provide the web link to the accreditation body’s website.

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

• A U.S. citizen or non-citizen national of the United States.

• A lawful permanent resident of the United States.

• Any other qualified alien as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Pub. L. 104-193.

Project Director Eligibility HRSA recognizes only one Project Director. The Project Director must be a board-certified physician assistant or board-certified primary care physician employed by the applicant organization at the time you submit the application. The project director should dedicate approximately 20% of their time to grant activities. The dedicated time can be through in-kind contributions or funded by grant funds. We do not allow co-project directors.

Cost Sharing This program has no cost-sharing requirements.

Program Description

Purpose This program’s purpose is to develop clinical rotations for primary care Physician Assistant (PA) students in rural areas. These rotations must be at least three months long. They will integrate behavioral health with primary care services.

This program addresses PA training for behavioral health conditions. These include prevention, identification, diagnosis, treatment, and referral services.

The goal is to increase the number of PAs trained to deliver these services in rural areas, including Medications for Opioid Use Disorder (MOUD).

Background The presence of serious mental illness is similar in rural and urban areas.i Yet, rural residents receive less-specialized, less routine treatment.ii Approximately one-fifth of the U.S. population resides in rural areas and 6.5 million of these individuals have a mental illness. iii In 2020, the Centers for Disease Control reported the opioid overdose death rate as

26.2 per 100,000 in rural areas. iv

People with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD) are at a higher risk of suicide; rural suicide rates increased by 46% from 2000 to 2020 in non-metro areas.

PAs are instrumental in identifying and treating behavioral health and SUD. About 30,000 PAs treat patients with concurrent behavioral health conditions daily.v Even then, only 2% of PAs currently specialize in psychiatry. vi The total supply of all psychiatrists will decline between 2017 and 2030.vii PAs trained in behavioral health can support this shortage.

As a profession, PA tracks will increase by 31% by 2029, with 10,000 students graduating per year in the U.S.viii The PCTE-PARB program supports educating PAs and providing clinical experience. This will improve practice competence and retention in rural areas.

Program Definitions The following definitions apply to the program for Fiscal Year 2024. The dictionary of key program-related terms in the Health Workforce Glossary is also useful.

Integrated behavioral health – Integrated behavioral health centralizes care for medical conditions and related behavioral health factors. In this NOFO, this is within the rural primary care setting.

Medications for Opioid Use Disorder (MOUD) – is an approach to opioid use treatment. It combines FDA-approved drugs with counseling and behavioral therapies.

Primary care – Under this program, are four distinct specialties, which include: family medicine, general internal medicine, general pediatrics, combined general internal medicine with general pediatrics.

Stipend – is an allowance for trainees to help pay for living expenses during their training experience. It is not provided as a condition of employment. It does not include tuition, fees, health insurance, or other support costs associated with the program.

Disadvantaged background — someone who is any or all of these: environmentally, economically, and educationally disadvantaged backgrounds.

Program Requirements and Expectations If you receive an award, you must meet the following expectations and address them in your application.

• Place trainees in rural clinical rotations within the first six months of receipt of the Notice of Award (NOA). There is no planning year for this program.

• Develop new or grow existing partnerships within the first six months after receipt of the NOA. Provide documentation of relationships with health care sites. See Attachment 3 and Attachment 7. You may add or develop extra partnerships during the period of performance.

• Provide curriculum that prepares trainees for clinical rotation. This includes managing prevention, identification, diagnosis, treatment, and referral services.

• Provide MOUD training for trainees.

• Incorporate interprofessional clinical and didactic learning for trainees.

• Provide trainees with at least three months of clinical rotations at a rural clinic. This work must involve integrating behavioral health with primary care. The clinical site must be rural as determined by the Federal Office of Rural Health Policy (FORHP). Use the Rural Health Grants Eligibility Analyzer.

• Provide a stipend to trainees while they are in a clinical rotation at a rural site. Students must be enrolled in your program to receive this stipend.

• Ensure trainees apply for a National Provider Identifier (NPI) number. This number must be collected from all students in the program.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://data.hrsa.gov/tools/rural-health

• Provide opportunities for preceptor development in behavioral health.

• Develop a plan to collect post-graduation employment demographics one year after graduation.

• Participate in federally designed evaluations to assess program effectiveness and efficiency.

Funding Policies & Limitations

General Policies

• This program depends on the appropriation of funds. If funds are appropriated for this purpose, we will move forward with the review and award process.

• The project director should dedicate approximately 20% of time (may be in-kind or funded by grants) to grant activities.

• Co-project directors are not an allowable cost.

• You cannot use grant funds to pay any person more than the rate for federal Executive Schedule Level II.

• You cannot use grant funds to buy real property, or for construction.

• You cannot use grant funds to pay for equipment costs not related directly to the purposes of this award.

• You must have policies, procedures, and financial controls in place. Anyone who receives federal funding must comply with legal requirements and restrictions, including those that limit specific uses of funding.

• Support beyond the first budget year will depend on:

- Continued appropriations.

- Satisfactory progress in meeting the project’s objectives.

- A decision that continued funding is in the government’s best interest.

Student Stipends We require award recipients to provide stipends to trainees. We only allow stipends for the PA students during the time of their rural primary care rotations. You may use stipends:

• Only for meeting cost-of-living expenses during training.

• Only while a student is training in a primary care rural rotation.

• For multiple rotations in rural primary care settings.

• Only for physician assistant students in the training program of the applicant organization.

https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2023/executive-senior-level https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2023/executive-senior-level

We set stipends at $2,262 per month for each month of the rural rotation. Prorate the amount for the student’s rural rotation if they train for a partial month as part of their total rotation.

You cannot provide stipends lower than the amount set above. You may choose to provide higher stipend amounts using funds from other non-federal sources.

We do not allow other trainee participant support costs such as tuition, travel, and conference fees.

Fringe Benefits for Physician Assistant Students Under this program, we do not allow unemployment insurance, life insurance, taxes, fees, retirement plans, or other fringe benefits. Health insurance is an allowable cost.

Evaluation Costs You may request funding to support annual reporting requirements including software, personnel time, and related costs. You may also request funds to conduct the required program evaluation. See Evaluation and Technical Support Capability.

Maintenance of Effort Federal funds must add to any existing non-federal funds for your proposed activities. If you receive an award, you will have to maintain at least the same spending level as in the fiscal year before the award. This policy is required by 42 U.S.C. § 295n-2(b). We will enforce this statutory requirement through all available mechanisms. You must provide supporting documentation in Attachments.

Other Limitations For guidance on allowable costs and restrictions, see Budget in section 4.1.iv of the Application Guide. You can also see 45 CFR part 75, General Provisions for Selected Items of Cost.

See Manage Your Grant for other information on costs and financial management.

Indirect Costs Indirect costs for training awards cannot exceed 8% of modified total direct costs. To understand what is included in modified total direct costs, see 45 CFR 75.2.

State or local governments and federally recognized Indian tribes can charge their negotiated rate or use their state cost allocation plans. For this purpose, we do not consider state universities or hospitals government agencies.

Program Income It is called program income if you make any income from your award-supported project activities. You will have to use those funds to add to approved project activities. Find out more about program income at 45 CFR 75.307.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=23 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-45/part-75#p-75.2(Modified%20Total%20Direct%20Cost) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply Get Registered 10

Find the Application Package 10

Application Writing Help 10

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Step 1: Review the Opportunity

Step 2: Get Ready to Apply

Step 3: Write Your Application

Get Registered

SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and click Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register.

When you register or update your SAM.gov registration, you must agree to the included Assurances.

Grants.gov You must also have an active account with Grants.gov. You can see step-by step instructions at the Grants.gov Quick Start Guide for Applicants.

Need Help? See Contacts & Support.

Find the Application Package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-24-019.

After you select the opportunity, we recommend you click the Subscribe button to get updates.

Application Writing Help Visit HHS Tips for Preparing Grant Proposals.

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

See Apply for a Grant for other help and resources.

Join the Webinar We will hold a pre-application technical assistance webinar for applicants. In it, we will provide an overview of key NOFO information. You will be able 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.

https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.grants.gov/web/grants/applicants/registration.html https://www.grants.gov/web/grants/applicants/registration.html http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/web/grants/search-grants.html https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant https://bhw.hrsa.gov/fundingopportunities/default.aspx

Step 3:

Write Your Application Application Contents & Format 12

Required Format 12

Project Abstract 12

Project Narrative 12

Budget & Budget Narrative 15

Attachments 17

Standard Forms 19

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Step 1: Review the Opportunity

Step 2: Get Ready to Apply

Step 3: Write Your Application

Application Contents & Format Applications include five main components. This section includes guidance on each.

There is a 60-page limit for the overall application. For more detail, see Application Checklist.

Submit your information in English and express budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission Form Included in the page limit?

Project Abstract Use the Project Abstract Summary Form. No

Project Narrative Research and Related Other Project Information

Yes

Budget Narrative Use the Research and Related Budget form.

(Line L)

Yes

Attachments Insert each in the Attachments form. Yes

Standard Forms Upload using each required form. Indicated in the Standard Forms section.

Required Format You must format your narratives and attachments using our required formats for fonts, size, margins, etc. See the formatting guidelines in section 4.2 of the Application Guide.

Project Abstract Complete the information in the Project Abstract Summary Form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more, see section 4.1.ix of the Application Guide.

Project Narrative In this section, you will describe all aspects of your project.

Use the section headers and the order below.

Introduction and Purpose See merit review criterion 1: Purpose & Need

Briefly describe the purpose of your project.

Include the efforts you will make to address the non-academic barriers to trainees’ access to education and success in your program. These barriers might include physical health, psychological health, physical environment, social environment, and economic stability.

Trainees include students participating in the program.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=41 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=40

Propose an actionable framework that targets learning disparities and offers opportunities to support diversity, equity, and inclusion. This framework may include the recruitment of students from rural and underserved areas. Project activities must comply with the non-discrimination requirements described in Non-Discrimination and Assurance.

Organizational Information See merit review criterion 4: Resources & Capabilities

• Briefly describe your mission, structure, and the scope of your current activities. Explain how they support your ability to carry out the program requirements. Include a project organization chart.

• Discuss how you will follow the approved plan, account for federal funds, and record all costs to avoid audit findings.

• Describe how you will assess the unique needs of the people who live in the community you serve.

• Describe the organizations you will partner with to fulfill program goals and meet training objectives. Include key agreements and letters of support in Attachment 3 and Attachment 7.

• Include a staffing plan and job descriptions for key faculty and staff in Attachment 2.

You will also include biographical sketches for people who will hold the key positions. Do this using the Research & Related Senior/Key Person Profile form.

Need See merit review criterion 1: Purpose & Need

Outline the needs of your program, which will train PAs in behavioral health. These programs will serve rural areas.

Approach See merit review criterion 2: Response

In your application, and consistent with the Program Requirements and Expectations:

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

• Explain your strategies to improve trainee cultural competence to:

- Meet the needs of underserved communities.

- Increase the use of culturally and linguistically appropriate services. Provide training based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

• Summarize your work plan, including:

- The activities or steps you will use to achieve each of the program objectives during bookmark://Att2/ https://thinkculturalhealth.hhs.gov/clas https://thinkculturalhealth.hhs.gov/clas the entire period of performance.

- The timeframes, deliverables, and key partners required during the period of performance. Address how they will meet each of the needs you describe in your Need section.

- How the work plan considers project design. Include how the targets fit into the implementation timeline.

- The collaboration with key stakeholders in planning, designing, and implementing all activities. Include their roles in developing the application and plans for future collaboration. Include how contributors address cultural, linguistic, and geographic diversity within communities served.

- If you plan to use subawards or contracts, describe how you will document and make sure you use funds appropriately.

You will also:

• Submit a more detailed Work Plan using the Standardized Work Plan (SWP) form.

• Provide a Physician Assistant Trainee Training Chart as Attachment 8.

Resolving Challenges See merit review criterion 2: Response

Discuss challenges you may encounter during the activities in the work plan. Include potential recruitment challenges with PA students and faculty in clinical rotation sites.

Explain approaches you will use to resolve them.

Evaluation & Technical Support Capacity See merit review criteria 3: Impact

Evaluations must adhere to the HHS Evaluation Policy, as well as the standards and best practices described in OMB Memorandum M-20-12.

• Describe the expected outcomes of the funded activities.

• Describe how you will collect, manage, and report required performance data accurately and on time. See Report on Your Grant for examples of reporting forms. Look for those under Primary Care Training Enhancement – Physician Assistant Rural Training Program. Note: We may change performance measures and data forms each academic year. Sample data elements that we may require include:

- PA students’ race, ethnicity, and gender.

- PA students’ disadvantaged and rural background as defined in the Health Workforce Glossary.

- PA students’ clinical training setting.

- PA students’ employment information at completion of the program and one year later.

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%7Ca124bcd0f48f49734a0108db15bc1e92%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638127670798899539%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=8ueiCkmhVkYaEwk1haAQRR6UB0IB7m3eQjv0%2B2RKtiQ%3D&reserved=0 https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf https://bhw.hrsa.gov/funding/report-on-your-grant https://bhw.hrsa.gov/glossary#d

• Document your procedure for collecting, managing, and storing data. Include how you will track graduates for up to one year. Report their National Provider Identifier (NPI) numbers. Project trainees in eligible disciplines must apply for an NPI.

• Describe your plan to evaluate the project. Consider how it will add to continuous quality improvement. The evaluation should monitor ongoing processes and progress towards goals and program objectives. Describe:

- The inputs, key processes, variables to be measured, and expected outcomes. Inputs might include organizational profile, collaborative partners, key personnel, budget, and other resources. Evaluations must follow the HHS Evaluation Policy, and standards and best practices in OMB Memorandum M-20-12.

- The evaluation barriers and your plan to address them.

• Describe the evaluation experience of your organization and staff. Include experience, skills, and knowledge, materials published, and previous evaluation work.

• Explain how you will disseminate project results, and how you will assess whether your dissemination plan is effective, whether the results are national in scope, and the extent of potential replication.

See Reporting for more information.

Sustainability See merit review criteria 3: Impact

We expect you to improve practices and outcomes for the target population. Propose a plan for project sustainability after the period of federal funding ends.

• Describe the actions you will take to:

- Highlight key elements of your projects. Examples include training methods or strategies that have been effective in improving practices.

- Obtain future sources of funding.

- Determine the timing to become self-sufficient.

• Discuss challenges you will likely encounter while sustaining the program. Include how you will resolve these challenges.

Budget & Budget Narrative See merit review criterion 5: Support Requested

The budget narrative supports the information you provide in the Research and Related Budget Form. The merit review committee reviews both.

It includes added detail and justifies the costs you requested. As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• Restrictions on spending funds. See Funding Policies & Limitations.

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%7Ca124bcd0f48f49734a0108db15bc1e92%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C638127670798899539%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=8ueiCkmhVkYaEwk1haAQRR6UB0IB7m3eQjv0%2B2RKtiQ%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://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

To create your budget narrative, see detailed instructions in section 4.1.v of the Application Guide. Below are some additional instructions specific to this NOFO.

Participant and Trainee Support Costs Trainee Support Costs Include the following allowable costs in Section E on the SF-424 R&R Budget Form for trainee support costs:

• List health insurance.

• Stipends - Ensure your budget breakdown includes the total for stipends and the projected number of trainees for each budget period. See Student Stipends.

• Identify the number of trainees.

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

• Do not include unallowable trainee support costs such as tuition, travel, and conference fees.

Preceptor Support Costs For applicants with preceptor support costs, include these in “Other” under Participant Support Costs on the SF-424 R&R Budget form.

List continuing education training and fees, conferences, and travel in your budget narrative. Also include the number of preceptors.

Ensure your budget breakdown separates preceptor costs and includes a separate subtotal entitled “Total Preceptor Support Costs”. We allow these costs only for preceptors (who are not employees of the applicant organization). They must also train PA students at rural clinical sites. Preceptors are consultants or contractors based on the institution’s business relationship with the preceptor. Allocate those costs to F. Other Direct Costs.

Subtotal for Participants and Trainees Include a subtotal entitled “Total Participant and Trainee Support Costs” with the summary of these costs

Consultant Services Identify each consultant, the services they will perform and the total number of days. Also identify travel costs and total estimated costs.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=33 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=33

Attachments Place your PDF attachments in order in the Attachments form. Name each clearly.

All attachments count toward the page limit.

Attachment 1: Accreditation Documentation You must provide documentation of your ARC-PA accreditation. Please do not provide the web link to the accreditation body’s website.

Attachment 2: Project Organizational Chart Provide a one-page diagram that shows the full project’s organizational structure. Include all aspects, not just the applicant organization.

Attachment 3: Letters of Agreement, Memoranda of Understanding, and Contracts Provide any documents that describe working relationships between your organization and others you cite in the proposal. Documents that confirm actual or pending agreements should clearly describe the roles of contractors, partners, and any deliverables. Make sure any letters of agreement are signed and dated.

Attachment 4: Maintenance of Effort Documentation You will include non-federal funds that support proposed activities. These include cash, in-kind, and other contributions. Do not include any federal funds. See the Maintenance of Effort requirement.

Use the sample format below to provide the Maintenance of Effort documentation.

FY Before Application:

Actual Non-Federal Expenditures

First FY of Award:

Estimated Non-Federal Expenditures

Attachment 5: Request and Documentation for Medically Underserved Funding Preference Include only if applicable to your project.

To receive a funding preference, include documentation that shows you qualify for the funding preference. See Selection Process.

Attachment 6: Staffing Plan & Job Descriptions See Section 4.1.vi of the Application Guide.

Include a staffing plan that shows any staff positions that will support the project. Include key information about each. Justify your staffing choices. Include education and experience https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=37 qualifications alongside your reasons for the amount of time requested for each staff position.

For key personnel, attach a one-page job description. It must include the role, responsibilities, and qualifications.

Attachment 7: Letters of Support Include only if applicable to your project.

Provide a letter of support for each organization or department involved in your proposed project. Letters of support must be dated. They must specifically indicate a commitment to the project such as in-kind services, dollars, staff, space, equipment, etc.

Attachment 8: Physician Assistant Training Chart You must provide the number of PA trainees who will be involved in your program. Include:

• The total number of PA students in your program

• The projected number of PAs trained per year by this grant program

• The projected number of PA students expected to graduate from the program each year of the project period

Physician Assistant Training Chart

Attachment 9: Documentation of Rural Rotation Sites Provide a table description of the experiential training site(s). Include site names, and the number of PA students who will train there each year of the grant. We provide a sample below.

Year Total Number of PA students in your training program

Projected number of PAs trained per year by this grant program

Projected number of PA students expected to graduate from the program each year of the project period

Year 1

Year 2

Year 3

Year 4

Year 5

Table 1: Behavioral Health Trainee Clinical Rotation Sites

Year Rotation Site

Name

Rotation Site Address

(EXAMPLE

Main Street, Town, State, Extended Zip Code)

Number of PA students who will train in this location per year.

Is Clinical Rotation designated as rural?

Rural Health Grants Analyzer

(Yes/No)

Rotation Site offers

MOUD

services (Yes/No)

Is the Clinical Rotation Site designated as a Mental Health HPSA?

HPSA Find

(Yes/No)

Year 1

Year 2

Year 3

Year 4

Year 5

Standard Forms Complete the standard forms listed below. You can find them in the NOFO application package in Grants.gov. Review them and any available instructions at Grants.gov Forms.

Forms Submission Requirement

Project Abstract Summary Form With application.

Research and Related Other Project Information With application.

Standardized Work Plan (SWP) form With application.

Research and Related Senior/Key Person Profile (Expanded) form

With application.

Research and Related Budget Forms With application.

R & R Subaward Budget Attachment(s) Form With application.

Attachments Form With application.

SF-424 R&R (Application for Federal Assistance)

With application.

Project/Performance Site Locations(s) With application.

Disclosure of Lobbying Activities (SF-LLL) If applicable, with the application or before the award.

https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/shortage-area/hpsa-find https://www.grants.gov/web/grants/forms/sf-424-family.html https://www.grants.gov/web/grants/forms/sf-424-family.html

Project Abstract Summary Form Does not count against the page limit

Follow the instructions in the form and in the Project Abstract section.

Research and Related Other Project Information Only the project narrative form attachment counts against the page limit

• Complete sections 1 through 6.

• Upload a blank document in item 7: Project Summary/Abstract to avoid a cross-form error with your Project Abstract Summary Form.

• Upload your project narrative in item 8.

• Leave items 9, 10, and 11 blank.

• If you have more than 10 subawards, you may use item 12 to add subaward budgets that could not fit in your R&R Subaward Budget Attachment(s) Form.

Standardized Work Plan Form Does not count against the page limit

Provide a detailed work plan that demonstrates your ability to implement a project of the proposed scope. You will submit your work plan using the Standardized Work Plan (SWP) Form. The contents of the form support your work plan summary in the Approach section.

The SWP form is organized by budget period. The form includes instructions.

You must:

• Include all activities and deliverables for each objective and program goal.

• Enter this NOFO’s goal, “to increase the number of PAs trained to deliver behavioral health services in rural areas, including preventing, identifying, diagnosing, treating, and referring services” in the Program Goals section.

• Enter the three program objectives listed in the Summary section.

• Include all activities and deliverables for each program objective and program goal.

• Enter “Health Equity” in the Other Priority Linkage box if the program objectives or sub-objectives align with those priorities.

To tag program objectives with organizational priorities, select applicable priorities on the SWP form.

Your Project Director must register in the HRSA electronic handbook (EHB) after the award to review and finalize your SWP.

bookmark://_Standard_Forms/ bookmark://Work_Plan_Summary/

Research and Related Senior/Key Person Profile (Expanded) form Counts against the page limit*

Include biographical sketches for people who will hold key positions. You will submit these using the Research and Related Senior/Key Person Profile (Expanded) form.

• Use only one page per person. These sketches count towards the page limit.

• Do not include personally identifiable information.

• If you include someone you haven’t hired yet, include a letter of commitment from that person with their biographical sketch.

• Include:

- Name and title

- Education and training. For each entry, include institution and location, any degree, date earned, and field of study.

- Section A Personal Statement. Briefly describe why the person’s experience and qualifications make them well-suited for their role.

- Section B Positions and Honors. List in chronological order their previous and current positions. List any honors. Include present membership on any federal government public advisory committee.

- Section C Other Support. This section is optional. List selected ongoing and completed projects during the last three years. Begin with those most relevant to the proposed project. Briefly indicate the overall goals of the projects and the key person’s responsibilities.

- Other information. If they apply, include language fluency. Also include any experience working with populations that are culturally and linguistically different from their own.

Research and Related Budget Form Only the budget narrative counts against the page limit

Follow the instructions in section 4.1.iv of the Application Guide.

You will complete the form for each budget year for the proposed performance period.

After completing the first budget period in the form, you may click “Add Period” to move to the next.

R&R Subaward Budget Attachment(s) Form Counts against the page limit*

You will also complete the Research and Related Budget form for each subaward you propose. These include subcontracts. You will do this using the R & R Subaward Budget Attachment(s) Form.

To complete the budget forms, follow the instructions in section 4.1.iv of the Application Guide.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=23 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=23 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=23

• Once you open this form, you can select “Click here to extract the R&R Subaward Budget Attachment”.

• Save the file and then open it to complete it.

• Once you save the file you can upload it within the form.

• Repeat the steps for each subaward.

If you have more than 10 subawards, you may upload the extra budget forms in the Research and Related Other Project Information form. See Block 12: “Other Attachments”.

Attachments Form Contents attached in the form count against the page limit.

Use this form to upload the Attachments.

SF-424 R&R Form Does not count against the page limit

Follow the instructions in section 4.1 of the Application Guide.

Project/Performance Site Form Counts against the page limit*

Follow the form instructions in Grants.gov

Disclosure of Lobbying Activities (SF-LLL) Form Does not count against the page limit

Follow the form instructions in Grants.gov.

* Only what you attach in these forms counts against the page limit. The form itself does not count.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-rr-app-guide.pdf#page=21

Step 4:

Learn About Review & Award Initial Review 24

Merit Review 24

Risk Review 27

Selection Process 28

Award Notices 30

Jump to another step

Step 1: Review the Opportunity

Step 2: Get Ready to Apply

Step 3: Write Your Application

Initial Review We review each application to make sure it meets basic requirements. We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

• Does not include the appropriate tables.

Also, if you do not follow page limit or formatting requirements, we may remove pages from your application to solve any unfairness. Project activities must comply with the non-discrimination requirements described in Non-Discrimination and Assurance.

Merit Review A panel reviews all applications that pass the initial review. The members use the criteria below.

Criterion Total number of points = 100

1. Purpose & Need 15 points

2. Response 35 points

3. Impact 20 points

4. Resources & Capabilities 20 points

5. Support Requested 10 points

Criterion 1: Purpose & Need 15 points

See Project Narrative Introduction and Purpose and Need sections.

Reviewers will consider the extent to which the application:

• Describes the purpose of the proposed project as it relates to the goal and program objectives.

• Documents the training need for PA students in preventing, identifying, diagnosing, treating, and referring services for behavioral health in rural areas.

• Describes how the applicant will address the non-academic barriers to learning and help trainees succeed in the program. Barriers include physical health, psychological health, physical environment, social environment, and economic stability.

• Provides a plan for implementing an actionable framework that targets learning disparities. It must also offer learning opportunities that support diversity, equity, and inclusion. This may include recruitment of students from rural and underserved areas.

Criterion 2: Response 35 points

See Project Narrative Approach, and Resolving Challenges sections. See Standardized Work Plan.

Criterion 2 (a): Work Plan (15 points) Reviewers will consider the extent to which the application:

• Provides detailed steps to achieve each of the program objectives and sub-objectives proposed during the period of performance.

• Provides a plan for implementing a didactic and clinical curriculum. This includes culturally competent content that prepares PAs for clinical rotations.

• Provides the timeframes, deliverables, and key partners required during the period of performance.

Criterion 2 (b): Approach (15 points) Reviewers will consider the extent to which the application:

• Provides a PA student training chart as Attachment 8.

• Describes curriculum the applicant will develop, and how it will be implemented. This includes providing faculty who train using the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

• Describes how the proposed project will incorporate one or more integrated behavioral health clinical rotations. These rotations are a minimum of three-months and are in a rural primary care setting.

• Describes how they will train PA students in MOUD.

• Describes how they will develop partnerships with community-based organizations.

These will provide inter-professional services that educate PA students in rural care.

Criterion 2 (c): Resolving Challenges (5 points) Reviewers will consider the extent to which the application:

• Describes the challenges and obstacles to program implementation. Demonstrates resources to overcome these challenges.

• Describes the challenges with providing clinical rotations for PA students in rural areas.

Provides plans to overcome these challenges.

Criterion 3: Impact 20 points

See Project Narrative Evaluation and Technical Support Capacity and Sustainability sections.

Criterion 3(a): Evaluation and Technical Support Capacity (10 points) Reviewers will consider the extent to which the application:

• Explains measurable outcomes. These cover the internal program performance evaluation plan and HRSA’s required performance measures. Specific criteria include:

- PA students’ race, ethnicity, and gender.

- PA students’ disadvantaged and rural background as defined in the Health Workforce Glossary .

- PA students’ clinical training setting.

- PA students’ employment information at completion of the program, and one year later.

• Describes how the applicant will collect data. This ensures a timely and accurate report of performance outcomes.

• Incorporates data collected into program operations for continuous quality improvement. Evidence that the evaluative measures will be able to assess:

- To what extent the program objectives have been met.

- To what extent these can be attributed to the project.

• Demonstrates how the applicant anticipates obstacles to the evaluation. Proposes how to address those obstacles.

• Describes the effectiveness and feasibility of plans to disseminate project results.

• Describes if project results are national in scope. Considers the degree to which the project activities are replicable.

• Includes a procedure for collecting, managing, storing, and reporting data on program participants. This should also include a process to track trainees for one year after program graduation.

Criterion 3 (b): Project Sustainability (10 points) Reviewers will consider the extent to which the application:

• Provides a plan to continue training PA students in rural areas beyond federal funding.

• Proposes a timetable for becoming self-sufficient.

Criterion 4: Resources & Capabilities 20 points

See Project Narrative Organizational Information section.

Reviewers will consider the extent to which the application:

• Describes how the applicant will fulfill the needs and requirements of the project.

• Documents the mission of the applicant organization. Describes the commitment to training PA students in integrated behavioral health in rural areas.

• Provides a staffing plan as Attachment 6 and project organizational chart as Attachment 2 that document the qualifications of the project staff.

• Provides evidence of institutional support. These can include letters of agreement and support, in-kind contribution of faculty and instructors, consultants, staff and resources, and other partners provided in Attachment 3 and Attachment 7.

• Demonstrates program capacity to provide academic partnerships, and community resources needed for trainees to meet the required competencies and clinical training experiences.

Criterion 5: Support Requested 10 points

See Budget & Budget Narrative section.

• How reasonable the proposed budget is for each year of the performance period.

• How well costs, as outlined in the budget and required resources sections, align with the scope of work.

• The extent to which key staff have adequate time devoted to the project to achieve program objectives.

Risk Review Before making an award, we need to review any possible risks. This section considered how you've handled past federal awards.

We:

• Review any past performance.

• Analyze the cost of the budget.

• Assess your management systems.

• Ensure you continue to be eligible.

• Make sure you comply with any public policies.

We may ask you to submit additional information.

As part of this review, we use SAM.gov Entity Information Responsibility / Qualification to check your history for all awards likely to be over $250,000. You can comment on your organization's information in SAM.gov. We'll consider your comments before making a decision about your level of risk.

If we find a significant risk, we may choose not to fund your application, or to place specific conditions on the award.

For more details, see 45 CFR 75.205.

Selection Process When making funding decisions, we consider:

• Merit review results. These are key in making decisions but are not the only factor.

• The amount of available funds.

• Assessed risk.

• The funding preference for Medically Underserved Community (MUC) (see below).

We may:

• Fund out of rank order.

• Fund applications in whole or in part.

• Fund applications at a lower amount than requested.

• Decide not to allow a prime recipient to subaward if they cannot monitor and manage subrecipients properly.

• Choose to fund any applications under this NOFO.

Funding Preferences This program includes funding preferences authorized by 42 U.S.C. § 295j (Section 791 of the Public Health Service Act). This requires a funding preference for any qualified application ranked at or above the 20th percentile of proposals approved by the merit review panel.

You must clearly indicate the basis for which you are requesting the funding preference in the Project Abstract. Provide supporting documentation in Attachment 5.

If we determine that your application qualifies for a funding preference, we will move it to a more competitive position among fundable applications.

Preference: Medically Underserved Community (MUC) Qualifications to meet the funding preferences:

This funding preference focuses on the number of graduates from your PA training program that are employed in MUCs.

https://sam.gov/content/entity-information https://www.ecfr.gov/current/title-45/section-75.205

You must provide all the requested data shown below.

For this NOFO, a MUC is defined as a geographic location or population of people eligible for designation by the federal government as one of these:

• Health Professional Shortage Area

• Medically Underserved Area

• Medically Underserved Population

• Governor’s Certified Shortage Area for Rural Health Clinic purposes

See Health Workforce Data, Tools, and Dashboards to determine whether the PA graduate is practicing in a medically underserved community, See on our website.

You can apply for one or more of the following qualifications. However, we will grant only one funding preference per application.

Qualification 1: High MUC Placement Rate

You can…