HRSA-25-007.pdf

Federal Office of Rural Health Policy

Notice of Funding Opportunity

Application due April 10, 2025

Rural Residency Planning and Development (RRPD) program Opportunity number: HRSA-25-007

Contents Before you begin 4

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 9

Award information 17

Step 2: Get Ready to Apply 19

Get registered 20

Find the application package 20

Application writing help 20

Step 3: Prepare Your Application 22

Application contents and format 23

Step 4: Learn About Review and Award 46

Application review 47

Selection process 56

Award notices 58

Step 5: Submit Your Application 59

Application submission and deadlines 60

Application checklist 62

Step 6: Learn What Happens After Award 64

Post-award requirements and administration 65

Contacts and Support 69

Contents 2

Appendix A: Medicare GME Information 73

Appendix B: Sample Attachment Templates 75

Appendix C: Glossary 77

Endnotes 79

Contents 3

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 registrations are 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 the application due date

Applications are due by 11:59 p.m. Eastern Time on April 10, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 4 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 7

Program description 9

Award information 17

Basic information Health Resources and Services Administration (HRSA)

Federal Office of Rural Health Policy

Policy Research Division

Creating new, sustainable residency programs to improve access to health care in America’s rural communities.

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name:

Rural Residency Planning and Development Program

Opportunity number:

HRSA-25-007

Announcement version:

New

Federal assistance listing:

93.155

Statutory authority:

42 U.S.C. § 912(b)(5) (§711(b)(5) of the Social Security Act)

Key dates

NOFO issue date:

January 10, 2025

Informational webinar:

January 23, 2025

Application deadline:

April 10, 2025, at 11:59 pm

ET

Expected award date is by:

July 1, 2025

Expected start date:

August 1, 2025

See other submissions for other time frames that may apply to this NOFO.

Summary The Rural Residency Planning and Development (RRPD) program improves and expands access to health care in rural areas by developing new sustainable rural residency programs, including rural track programs (RTPs). Under the program, we provide start-up funding to grant recipients to create rural residency programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

These residency programs are then sustained long-term through viable and stable funding mechanisms, such as Medicare, Medicaid, and other public or private funding sources.

Ultimately, this funding opportunity aims to address physician workforce shortages and challenges faced by rural communities.

Funding details Application type: New

Expected total available funding in FY 2025: $11,250,000

Expected number and type of awards: 15 grants

Funding range per award: Up to $750,000 per grant

We plan to fund awards fully in Year 1 for the three-year period of performance (August 1, 2025, to July 31, 2028).

The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 6 https://www.acgme.org/initiatives/medically-underserved-areas-and-populations/rural-tracks/

Eligibility Who can apply You can apply if you meet all the eligibility criteria for funding under this notice.

Types of eligible organizations These types of domestic* organizations may apply:

• Public or private institutions of higher education, as part of a graduate medical education (GME) consortium, including:

◦ Schools of allopathic medicine

◦ Schools of osteopathic medicine

◦ Historically Black Colleges and Universities (HBCUs)

• Rural hospitals

• Rural community-based ambulatory patient care centers, including Rural Health Clinics

• Native American tribal governments

• Native American tribal organizations

*“Domestic” means the 50 states, the District of Columbia, 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, and the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

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

• Does not include all required attachments and narrative sections including a sustainability plan.

• Is not responsive to the purpose of the program, the sustainability plan requirements, or requirements for attachments.

• Fails to propose a new rural residency program in a qualifying medical specialty with greater than 50% of training at rural training sites.

Step 1: Review the Opportunity 7

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

• Is submitted after the deadline.

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

Step 1: Review the Opportunity 8

Program description Purpose The purpose of the Rural Residency Planning and Development (RRPD) program is to improve and expand access to health care in rural areas by developing new sustainable rural residency programs, including rural track programs (RTPs).

These residency programs must achieve accreditation from the Accreditation Council for Graduate Medical Education (ACGME). Newly created rural residency programs will increase the number of future physicians training in rural areas, and ultimately the number of physicians practicing in rural areas with the goal of addressing the physician workforce shortages in rural communities.

The RRPD program provides start-up funding to create new rural residency programs in qualifying medical specialties that will be sustainable long-term through viable and stable funding mechanisms, such as Medicare, Medicaid, and other public or private funding sources. Qualifying medical specialties are family medicine, internal medicine, preventive medicine, psychiatry, general surgery, and obstetrics and gynecology.

For this notice of funding opportunity (NOFO), rural residency programs:

• Are accredited physician residency programs.

• Train residents in clinical training sites that are physically located in a rural area as defined by HRSA’s Federal Office of Rural Health Policy (FORHP) [1] for greater than 50 percent of their total time in residency.

• Focus on producing physicians who will practice in rural communities.

The purpose of the RRPD Program is to fund the development of new rural residency programs in qualifying medical specialties. For this funding opportunity, we consider “new” programs to include both programs seeking accreditation for the first time and existing programs that apply for a permanent complement increase to train additional residents at new rural training site(s) as part of an RTP. To be responsive to the program purpose and be considered for funding, you must propose a new rural residency program in a qualifying medical specialty. For this funding opportunity, we do not consider the following to be new programs:

• Programs that have received accreditation or a permanent complement increase for their proposed rural residency program before the application due date.

• Programs seeking to increase resident full-time equivalents at an existing RTP site without adding a new rural training site.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.acgme.org/initiatives/medically-underserved-areas-and-populations/rural-tracks/ https://data.hrsa.gov/tools/rural-health

Program pathways There are two pathways for this program. In your application, you will specify to which pathway your proposed residency program corresponds.

Pathway 1: General primary care and high-need specialty This pathway supports developing new rural residency training programs that focus on training to meet significant rural health needs.

The qualifying specialties in this pathway are family medicine, internal medicine, preventive medicine[2], psychiatry, and general surgery.

Pathway 2: Maternal health and obstetrics This pathway supports developing new rural residency programs with a focus on training to provide high-quality, evidence-based maternity care and obstetrical services in rural areas.

Qualifying specialties in this pathway are obstetrics-gynecology and family medicine with enhanced obstetrical training.

Enhanced obstetrical residency training must provide family medicine residents with extensive clinical experience in comprehensive maternity care, as outlined in ACGME’s program requirements. This includes dedicated training on labor and delivery.

These programs must have faculty with clinical expertise to prepare family medicine residents for the independent practice of obstetrics in rural communities.[3]

Program goals The program’s goal is for each recipient to establish a new rural residency program in a qualifying specialty by the end of the period of performance.

These programs must be accredited by ACGME and sustainable long-term through viable stable funding streams, such as Medicare, Medicaid, and other public or private funding sources.

Funded rural residency programs will effectively train physicians to practice in and meet the clinical needs of rural populations. As a result, we expect a markedly higher proportion of graduates from these programs to enter careers serving rural populations when compared to traditional urban-based residency programs across the nation.

Program objectives To achieve this goal, you must achieve the following objectives if funded:

• Develop a new rural residency program that is accredited by ACGME.

Step 1: Review the Opportunity 10

• Finalize a validated sustainability plan that includes ongoing funding streams to sustain long-term resident training after the program is established.

• Develop a structured plan to track and publicly report on resident career outcomes after graduation for at least 5 years after the first graduating class to assess retention in rural communities.

Background One in five Americans live in rural communities.[4] Compared to their urban counterparts, people living in rural communities have higher rates of chronic conditions and preventable hospitalizations.[5] They also lack access to timely care.[6]

In fact, 71 percent of areas designated as primary medical health professional shortage area (HPSA) are in rural or partially rural areas.[7]

At the same time, national trends show the demand for physicians will continue to grow, outpacing the projected supply. Recent data from HRSA’s Bureau of Health Workforce projects a shortage of 139,940 physicians across primary care and non-primary care specialties by 2036.[8] The maldistribution of the physician workforce contributes to these shortages. Urban areas have more physicians, while rural and underserved communities experience the greatest need for health care providers.

Retaining and recruiting physicians continues to remain a critical issue for rural communities. One proven strategy is rural residency training. A recent study found that rural exposure during family medicine residency training is associated with a five- to six-fold increase in choosing rural practice.[9] A second study found rural training is more strongly associated with rural practice than having a rural background.[10] Despite the demonstrated successes of rural training, research finds persistently limited opportunities for physician residents to train in rural areas. According to the U.S.

Government Accountability Office, only 2 percent of residency training occurred in rural areas between 2014 to 2015 and 2019 to 2020. Instead, residency training is highly concentrated in urban areas, particularly in the southern and northeastern regions.[11]

Rural residency programs often face financial, human resource, and organizational capacity constraints. These include lack of sustainable financing, limited faculty support, and difficulties recruiting residents. Due to these challenges, few new residency programs started in rural areas in the past. In recent years, HRSA-funded grantees have shown that rural residency programs can overcome these challenges through strong partnerships, community champions, and start-up resources. Further, current Medicare graduate medical education (GME) payment policy includes several provisions that can provide new Medicare GME funding for new residency programs in rural facilities. These Medicare GME payments can be an important part of a program’s financial sustainability.

Step 1: Review the Opportunity 11

This program came out of the urgent need to develop new rural training opportunities.

HRSA’s Federal Office of Rural Health Policy (FORHP) administers the program in consultation with HRSA’s Bureau of Health Workforce (BHW). HRSA funded its inaugural cohort in FY2019 and additional cohorts in FY2020–24. HRSA has made 85 RRPD program awards across 38 states and 1 territory to develop rural residencies, including rural track programs, in the six qualifying specialties.

As of October 1, 2024, 47 program recipients have created new rural residency programs for a total of 587 approved residency positions. Forty-four of these residency programs have matriculated more than 460 physician residents. To navigate the complexities of accreditation and GME financing, all recipients are required to collaborate with the HRSA-funded RRPD Technical Assistance Center and attend a 2-day annual RRPD program meeting throughout the duration of their period of performance.

Please see helpful websites for additional resources and our glossary of important program definitions.

Program requirements and expectations We expect all applicants funded under this funding opportunity to develop strong and sustainable residency programs in qualifying medical specialties. To achieve that goal, you must meet critical milestones for each of the program objectives during the three-year period of performance.

In addition to achieving accreditation, you must also finalize a validated sustainability plan and develop a structured plan to track and report your residency program’s graduate outcomes.

Program milestones We expect recipients to meet the following critical milestones for each objective of the program:

Objective 1: Residency program development

• Appoint a residency program director or identify a residency program director in development by the end of the first year (July 31, 2026).

• Submit the ACGME application for the new rural residency program or rural track program by the end of the second year (July 31, 2027).

• Establish a new ACGME-accredited rural residency program or rural track program by the end of the period of performance (July 31, 2028).

• Begin training first resident class no later than the first academic year (AY) after the RRPD period of performance ends (AY2029).

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://ruralgme.org/

Objective 2: Program sustainability

• Finalize detailed pro forma for program sustainability by the end of the first year

(July 31, 2026).

Objective 3: Graduate tracking plan

• Finalize and submit detailed graduate outcome tracking plan by the end of the second year (July 31, 2027).

Program sustainability You are expected to finalize a validated sustainability plan that includes ongoing funding streams to sustain long-term resident training through one or more of the following options:

• Qualifying under current regulatory authority for viable Medicare payments for GME, such as Indirect Medical Education (IME) or Direct Graduate Medical Education (DGME) payments, for hospitals starting a new residency training program.

• Expanding a rural track program to a new rural site in accordance with Medicare regulations that qualifies for viable IME or DGME payments.[12]

• Qualifying for Medicaid GME, other state, public, or private support.

• Combining multiple funding streams (for example, a hospital may have a mix of Medicare and other public funding).

Medicare sustainability options If your sustainability plan relies on Medicare GME, you must select one or more of the following options:

Option 1 – Rural hospital “new” residency program Rural teaching hospitals may be eligible to receive an increase in their Medicare FTE resident cap if they start a new medical residency training program in the rural hospital.

For example, a rural hospital with an accredited family medicine residency program may be eligible for an increase in its resident caps if it starts training residents in a new psychiatry program.

Current Medicare regulations do not provide cap increases when a rural hospital expands the number of FTE residents in an existing program, or if an existing residency program is transferred to a new training site.

Step 1: Review the Opportunity 13

Option 2 – Medicare FTE resident cap expansion for rural track programs Urban and rural hospitals that establish a rural track program or add an additional rural site to an existing rural track program that is accredited by the ACGME may qualify for an adjustment to their GME FTE resident caps.

Effective for cost reporting periods on or after October 1, 2022, a rural track program is an ACGME-accredited program in which residents train for greater than 50 percent of their residency training in a rural area (as defined at 42 CFR 412.62(f)(iii)).

This regulation defines rural areas as areas outside of a metropolitan statistical area.[13]

Option 3 – Establishing a Medicare FTE resident cap for the first time Rural hospitals that have not yet triggered their per resident amount (PRA) and do not yet have GME FTE resident caps set (“never claimers”) are eligible to select this option.

To demonstrate that the PRA has not yet been triggered, rural hospitals must demonstrate that no prior residency training has taken place in their hospital and no previous caps have been set through a careful examination of past cost reports since 1996.[14]

Option 4 – Medicare FTE cap adjustment for rural reclassified hospitals Inpatient Prospective Payment System (IPPS) hospitals located in an urban area, but reclassified as rural under 42 CFR 412.103, may be eligible to receive an increase in their Medicare IME resident cap when they begin a new residency program.[15]

However, they are not eligible for a Medicare DGME cap increase unless they serve as the urban partner in a rural track program.

When participating in a program that is simultaneously a rural track program and a new residency program, a rural reclassified hospital serving as the urban partner in the rural track program could be eligible for a DGME rural track program cap increase and an IME new program cap increase. (See Option 2 – Medicare FTE resident cap expansion for rural track programs.)

Current Medicare regulations do not provide IME cap increases when a hospital expands the number of FTE residents in an existing program.[16]

IME for rural reclassified hospitals may be a viable sustainability funding stream as part of a larger sustainability plan but may not be sufficient by itself to ensure program sustainability.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412/subpart-D/section-412.62#p-412.62(f)(1)(iii) https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412/subpart-G/section-412.103

If your sustainability plan relies on the rural reclassified status of a hospital outside of the rural track program model, you must include other funding sources as part of the overall sustainability plan.

Option 5 – Medicare reasonable cost payments for Critical Access Hospitals Critical access hospitals (CAHs) may be a training site for a rural residency program.

Because these are not IPPS hospitals, typical GME formulas are not involved in their Medicare payments.

Instead, a CAH’s GME payment is based on 101 percent of reasonable costs that the CAH itself incurs for the residency program, pro-rated for Medicare patient share.

These payments are usually not sufficient by themselves to ensure program sustainability, since the allowable teaching costs incurred by CAHs when pro-rated for Medicare patient share are unlikely to fully cover their direct teaching costs.

If you therefore plan to use GME payments to a CAH as a part of your sustainability plan, you must include additional realistic, long-term funding sources to adequately ensure program sustainability.

Critical Access Hospitals may also participate in residency training as part of a larger GME consortium. Under current regulation, IPPS hospitals may claim residents’ time at a Critical Access Hospital, considering this hospital as a nonprovider site for GME purposes. The IPPS hospital must cover the residents’ salary and benefits while they train at the CAH. Typically, under this option, IPPS hospitals and CAHs develop funds flow agreements to help cover the costs associated with hosting the residency training.

If a CAH is serving as a nonprovider site as part of your GME consortium, you should use the most appropriate sustainability option from Medicare sustainability options 1, 2, or 3.

Non-Medicare sustainability options

Option 6 – Other public or private funding Rural residency programs may also be supported by funding sources other than Medicare.

Examples include ongoing funding from Medicaid, state sources, or other public or private funding streams.

Step 1: Review the Opportunity 15

Graduate tracking plan If funded, you must develop and submit a structured plan to track and publicly report on resident career outcomes after graduation. Outcomes must be tracked for at least 5 years after the first graduating class to assess retention in rural communities.

To consistently track graduates, you must identify and establish data collection elements for the graduate tracking plan.

At a minimum, the graduate tracking plan must accurately collect the following graduate outcomes:

• National Provider Identifier (NPI).

• Practice locations.

• Medical specialty/sub-specialty.

• Employment status (part-time or full-time).

Examples of other information you might collect include:

• Patient population served.

• Service time committed to the care of safety net patients.

• Part or full-time clinical practice status.

• Services offered.

• Proportion of clinical time in inpatient and outpatient settings.

• Additional training opportunities pursued after residency completion.

You must also track program performance data and should consider adding these measures to your plan for tracking graduate outcomes.

Refer to the Annual Performance Report Program Manual for examples of program performance data.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 16 https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=True&EHBActivityCode=p13

Award information Funding policies and limitations Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• We distribute the full award amount in the first year of the three-year period of performance. While you must allocate the award funding across each of the three years, the budget does not need to be evenly split across the three-year period of performance and can vary based on your program’s needs.

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list.

◦ Extend the period of performance.

◦ Award supplemental funding.

General limitations

• For guidance on some types of costs we do not allow or restrict, see Project

Budget Information in Section 3.1.4 of the Application Guide. You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items of Cost.

• You cannot earn profit from the federal award. See 45 CFR 75.400(g).

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2024, the salary rate limitation is $221,900. This limitation may be updated.

Program-specific statutory or regulatory limitations You cannot use funds under this notice for the following:

• Acquiring or building real property.

• Major construction or major renovation of any space. (Minor renovations or alterations are allowable.)

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

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=19 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.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.400 https://www.hrsa.gov/grants/manage-your-grant

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects).

To charge indirect costs you can select one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 – De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) 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

In this step

Get registered 20

Find the application package 20

Application writing help 20

Get registered SAM.gov You must have an active account with SAM.gov to apply. 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 select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

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.

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-25-007.

After you select the opportunity, we recommend you select 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.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 20 https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants 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

Join the webinar For more information about this opportunity, join the webinar:

• Thursday, January 23, 2025

• 2 p.m. ET

• Join at this Zoom link.

If you are not able to join through your computer, you can call in:

• Phone Number: 833-568-8864

• Meeting ID: 160 387 3976

• Passcode: 95106394

We will record the webinar. If you are not able to join live, you can replay it on our website.

Have questions? Go to Contacts and Support.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 21 https://hrsa-gov.zoomgov.com/j/1603873976?pwd=tvkkTMbH0f5Vyab3cTddZ7UF1pA11b.1 https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd/faq https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd/faq

Step 3:

Prepare Your Application

In this step

Application contents and format 23

Application contents and format Applications include five main components. This section includes guidance on each.

Application page limit: 60 pages

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

Make sure you include each of these:

Components Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form.

Attachments Insert each in the Attachments form.

Other required forms Upload using each required form.

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3.2 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 information, see Section 3.1.2 of the Application Guide.

Additionally, in the project abstract section of your form, include the following items in list format first, followed by the narrative content indicated:

• Eligible entity/facility type (for example, rural hospital. See Eligibility.)

• Program pathways. Select one or both:

◦ General Primary Care and High Need Specialty pathway residency

◦ Maternal Health and Obstetrics pathway residency

• Residency medical specialties

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 23 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf

• Residency format. Select one:

◦ Rural residency program (non-RTP)

◦ New rural track program, or RTP (new program accreditation)

◦ Rural track program expansion (adding new rural training site or sites to existing program)

• Sponsoring institution name, location, and ACGME sponsor program code (if applicable)

• Rural target county or counties

• Funding amount requested

• Program sustainability option (refer to Program Sustainability.)

• Projected total number of residents

• Expected ACGME accreditation and first resident matriculation dates

• Funding priority points requested, if applicable. (See Attachment 9 and Selection process.)

• List of recent HRSA awards received within the last 5 years, if applicable, by program name and grant number (for example, Rural Residency Planning and Development Program, Grant No. P13RH99999)

Project abstract narrative content

• Provide a brief overview of the project, including description of geographic area, target patient population and needs, consortium members (if applicable) and clinical collaborations (for example, training partners and types of clinical facilities).

• Include specific measurable objectives and expected outcomes of the project and how you will accomplish what you propose (i.e., the “who, what, when, where, why, and how” of the project).

Project narrative In this section, you will describe all aspects of your project. Project activities must comply with the nondiscrimination requirements.

Use the section headers and the order listed.

Step 3: Prepare Your Application 24

Introduction See merit review criterion 1: Need

• Briefly describe the purpose of your project.

• Identify specific goals, objectives, and expected outcomes.

• Summarize how your project will address population health needs and expand your project’s proposed medical specialty in your target area.

Need See merit review criterion 1: Need

Summarize the health workforce and health care needs of the target area served by your proposed project. Focus this section on assessing the current health care infrastructure (such as GME landscape) and describing the resources needed to develop a new rural residency program.

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

Specifically, you must:

• Describe the geographic area where you plan to start the new rural residency program and explain why you chose this target area.

• Describe the unmet health care needs that the residency program will address.

Whenever possible, include data on the demographics, social determinants of health, health disparities, and health care needs of the population served, as well as barriers to accessing care.

• Describe the area’s health workforce shortages and need for physicians in your proposed medical specialty. Include current (within 3 years) information and data demonstrating the need for the proposed specialty in the target area.

• Indicate the presence of geographic or population Health Professional Shortage Areas (HPSA) for primary care or mental health.

• Describe the rural health care delivery system and the specific needs of the facility or facilities hosting your proposed rural residency program. Include information on the organization’s structure and the clinical and faculty capacity needed to support the new rural residency program.

• List any residency programs (existing or in development) in the proposed qualifying medical specialty that serve the target area where the proposed new rural residency program will be located.

• Describe any progress made towards developing a rural residency program.

Step 3: Prepare Your Application 25

• Describe existing residency program collaborations and efforts to develop clinical training sites and to support preceptor development and retention.

• Describe any consultations with the State Office of Rural Health related to the planning and development of the new rural residency program. You must also at a minimum include the required letter of intent and any response received as Attachment 8.

Letter of Intent: Notify the State Office of Rural Health in any state where you have proposed to conduct rural training of your intent to apply to this program. For a list of the state offices,[17] visit the National Organization of State Offices of Rural Health (NOSORH) member list. We recommend making every effort to contact your state office early in the application process to advise them of your intent to apply.

• If you are pursuing the Maternal Health and Obstetrics Pathway, you must also:

◦ Describe gaps in the obstetrics services and existing resources available to care for individuals and families with high-risk factors in pregnancy.

◦ Include current state or county-level data on demographics, social determinants of health, and health disparities faced by the target population.

Discuss their maternal health needs, including prevention and treatment of risk factors during pregnancy, such as diabetes, heart disease, hypertension, obesity, depression, and opioid use disorder (OUD) and substance use disorder (SUD). You may use maternal health indicators from HRSA’s Maternal and Infant Mapping Tool.

Approach See merit review criterion 2a: Approach

Tell us how you’ll address your stated needs and meet the program’s goals, objectives, requirements, and expectations. See Program goals, Program objectives, and Program requirements and expectations sections.

Describe how your approach will bridge any gaps identified in the Need section.

Specifically, tell us how you will:

• Achieve ACGME accreditation for the new rural residency program or permanent complement increase for the new rural track program expansion in a qualifying specialty no later than the end of the period of performance (July 31, 2027).

Describe:

◦ Your program’s proposed sponsoring institution and whether it has received institutional accreditation. If not yet accredited, describe your plans to achieve institutional accreditation.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 26 https://plus.nosorh.org/Web/Membership/Directory/State_Members_List.aspx https://plus.nosorh.org/Web/Membership/Directory/State_Members_List.aspx https://data.hrsa.gov/maps/mchb/ https://data.hrsa.gov/maps/mchb/

◦ Your program’s proposed clinical training sites. Provide a table in Attachment 1 that includes all your proposed clinical training facilities and demonstrates that greater than 50% of the training will take place in facilities physically located in rural areas as defined by HRSA’s Federal Office of Rural Health Policy (FORHP).

◦ Your plan to make sure your clinical capacity meets ACGME program accreditation requirements, including enough dedicated supervisory faculty, adequate patient care volume, and appropriate resident training time in relevant medical specialties and subspecialties (such as obstetrics training).

If a clinical training partner addresses gaps in existing clinical capacity to meet ACGME requirements and provides significant support, you must submit a Letter of Agreement from the clinical partner describing their committed resources and clinical capacity in Attachment 5.

◦ Your sponsoring institution’s plan to ensure required organizational capacity and program governance structure meet both ACGME sponsoring institution and program accreditation requirements, including hiring non-faculty staff, and acquiring access to electronic health records, library services, learning management systems, etc.

◦ Your plan to appoint a residency program director by the end of year 1 of the grant (if not already hired), and your faculty recruitment and development plan, including recruiting specialty faculty to meet ACGME requirements for the proposed specialty.

◦ Your curriculum and training plan, including incorporation of interprofessional training, culturally and linguistically appropriate care, and training to address the health inequities and disparities of the patient population in the rural target area. Your curriculum plan must lead to successful board certification of graduates and readiness for clinical practice following completion of training.

• Enroll residents in training no later than the academic year immediately following the end of the program period of performance (AY2029). Describe your plan to:

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

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

◦ Promote retention among residents and graduates to practice in rural communities.

• Track residents’ career outcomes for at least 5 years after the first graduating class from the rural residency program. Describe how you’ll:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 27

◦ Develop, enhance, or leverage a graduate tracking system to track and publicly report (e.g., on your program website) on graduates’ career outcomes and retention in rural and underserved areas. At a minimum, the graduate tracking plan should accurately collect the following information about graduates:

▪ National Provider Identifier (NPI).

▪ Practice locations.

▪ Medical specialty/sub-specialty.

▪ Employment status (part-time or full-time).

• Describe a plan to disseminate reports, products, or project outputs so project information may inform other rural residency programs to pursue this model as a strategy for training physicians likely to seek rural practice.

• Describe innovative approaches or unique program characteristics that would enhance the quality of rural residency training to meet the needs of the targeted rural area, such as:

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

◦ Integrating interprofessional education and practice.

◦ Integrating oral health.

◦ Providing mental health and SUD treatment.

◦ Incorporating public health emergency preparedness and response training.

• If you are pursuing the Maternal Health and Obstetrics Pathway, you must also:

◦ Describe the type of training sites for obstetrics training and the range of services at the clinical training sites, including ambulatory care for maternal health in the locality of the program. Include the number of anticipated vaginal deliveries and C-sections per year, as applicable.

◦ If applicable, describe how you plan to enhance the family medicine residency program in maternal health and obstetrical training, referencing current ACGME requirements. Describe how you’ll meet these requirements to train family medicine residents for the independent practice of obstetrics in rural communities.[18]

▪ Describe the number of preceptors and faculty members that provide maternal health care and the types of maternity and obstetrics services they perform in sites where the residents will train.

▪ Clearly identify the percentage of time and types of maternal health/ obstetrics services the residents will perform or experience while training in rural communities.

Step 3: Prepare Your Application 28

High-level work plan See merit review criteria 2b: Work plan

• Describe how you’ll achieve each of the program goals and objectives identified in the Project Narrative Approach section during the period of performance.

• Provide a timeline that includes each activity and identifies the faculty/staff or key collaborator who is responsible for each. Key faculty/staff identified in the work plan must correspond with the staffing plan in Attachment 3. Provide Letters of Agreement from all key collaborators in Attachment 5.

• Identify how key stakeholders will help plan, design, and carry out all activities, including developing the application. Discuss the extent to which these contributors reflect the populations and communities served. Provide Letters of Agreement from all GME consortium members in Attachment 5.

• Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of the grant.

• Include a more detailed work plan in Attachment 2. You should use this plan to achieve each of the program goals and objectives listed in the program description’s Purpose section. A sample work plan is included in Appendix B for your reference.

Resolving challenges See merit review criterion 2c: Resolving challenges

Discuss challenges that you are likely to encounter when implementing your work plan and explain approaches that you’ll use to resolve them.

Specifically, you must:

• Discuss challenges and barriers in implementing your work plan to achieve program goals and objectives. Examples include inadequate clinical experiences or patient volumes for residents, recruiting specialty and subspecialty preceptors needed to meet ACGME requirements, and financial sustainability issues. Propose reasonable strategies to address these challenges.

• Discuss any expected internal challenges (such as managing expectations among clinical training partners) and external challenges (like regulatory changes) that may directly or indirectly affect the development of the rural residency program.

Provide strategies for how you will overcome them.

• Describe challenges incorporating interprofessional health care, innovative approaches, and culturally and linguistically appropriate care in the program curriculum. Propose resolutions to these challenges.

Step 3: Prepare Your Application 29

• Describe challenges recruiting a diverse cohort of high-quality residents. Discuss strategies to overcome recruitment challenges.

Include references to ACGME program requirements wherever possible when addressing any challenge related to meeting accreditation requirements.

Performance reporting and evaluation See merit review criteria 3a: Evaluation measures

Describe your proposed plan to monitor ongoing processes and progress towards meeting project goals, objectives, and expected outcomes.

Performance measurement and reporting See reporting manual for performance measure requirements and examples of reporting forms.

• Describe how you will collect, and report required performance data accurately and on time.

• Describe how you will manage and securely store data.

• Describe how you will monitor and analyze performance data to support continuous quality improvement. Specifically, describe a plan to collect and report on the following performance measures for your residency program, in addition to the plan for tracking characteristics of graduates, practice locations, and intent to be employed in rural areas required in the Approach section:

◦ Accredited positions

◦ Admissions

◦ Residents by:

▪ Year of training

▪ Age

▪ Gender

▪ Race

▪ Ethnicity

◦ Location of training

◦ New curriculum development

◦ Faculty development

• If funded, you must report on selected characteristics of residents during the period of performance. Refer to the Annual Performance Report Program Manual

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 30 https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=True&EHBActivityCode=p13 https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=True&EHBActivityCode=p13 for examples of performance data. You must provide a table of anticipated values for the following initial outputs in your application:

◦ Number and type (i.e., model and specialty) of newly established rural residency programs.

◦ Number of residents each rural residency program can support in the first year.

◦ Number of residents each rural 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 rural residency program site.

◦ Number and type of existing collaborations (e.g., non-clinical training site) that support the rural residency program.

◦ Number and type of newly established collaborations (e.g., non-clinical training site) that support the rural residency program.

Program evaluation Describe the plan for the program performance evaluation that will meet ACGME accreditation requirements and promote continuous quality improvement. Include:

• Clearly defined, viable metrics, including descriptions of the inputs (e.g., key personnel, collaborators, and other resources), key processes, and meaningful expected outcomes of the funded activities.

• The evaluation barriers and your plan to address them.

• The evaluation capacity of your organization and staff. Describe experience, skills, and knowledge.

See Reporting for more information.

Program sustainability See merit review criteria 3b: Program sustainability

You must propose a clearly defined, fact-based, validated sustainability plan to support the long-term financial sustainability for the new rural residency program beyond the RRPD period of performance. You must:

• Describe a financial sustainability plan by selecting one or more of the sustainability options described in this NOFO to support the costs of your new rural residency program. Describe any financial investments you have already made. See the Program sustainability section of Program requirements and

Step 3: Prepare Your…