HRSA-25-069 FINAL 12-23.pdf

Notice of Funding Opportunity

Application due February 28, 2025

Bureau of Health Workforce Division of Medicine and Dentistry

Addiction Medicine Fellowship Program Opportunity number: HRSA-25-069

Modified on 12/23 - Removed BHW Program Specific form information from NOFO and Application Package

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 6

Program description 8

Award information 12

Step 2: Get Ready to Apply 14

Get registered 15

Find the application package 15

Application writing help 15

Step 3: Prepare Your Application 17

Application contents and format 18

Step 4: Learn About Review and Award 34

Application review 35

Award notices 45

Step 5: Submit Your Application 46

Application submission and deadlines 47

Application checklist 48

Step 6: Learn What Happens After Award 50

Post-award requirements and administration 51

Contacts and Support 55

Endnotes 58

Contents 2

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 February 28, 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 3 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 5

Eligibility 6

Program description 8

Award information 12

Basic information Health Resources and Services Administration (HRSA)

Bureau of Health Workforce

Division of Medicine and Dentistry

Training addiction specialists to deliver integrated care in medically underserved communities.

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name: Addiction Medicine Fellowship Program

Opportunity number: HRSA-25-069

Announcement version:

New

Federal assistance listing: 93.732

Statutory authority: 42 U.S.C. § 294k(a)(1) (Section 760(a)(1) of the Public Health Service Act)

Key dates

NOFO issue date:

December 20, 2024

Informational webinar:

Visit BHW’s open opportunities for details.

Application deadline:

February 28, 2025

Expected award date is by: July 1, 2025

Expected start date:

July 1, 2025

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

Summary The purpose of the Addiction Medicine Fellowship (AMF) program is to expand the number of fellows at accredited AMF and Addiction Psychiatry Fellowship (APF) programs trained as addiction medicine specialists who practice in medically underserved, community-based settings that integrate primary care with mental health disorder and substance use disorder (SUD) prevention and treatment services. The fellowship must include training in prevention and treatment services in medically underserved, community-based settings, including in rural areas, that do not have access or have limited access to SUD treatment. The program includes training for both addiction medicine and/or addiction psychiatry fellows. Its goal is to increase the number of physicians who are board-certified specialists in addiction medicine or addiction psychiatry who will serve in medically underserved community-based settings, including in rural areas, once trained. The program supports training to:

• Increase the number of fellows trained to practice addiction medicine and addiction psychiatry in rural and other medically underserved community-based settings.

• Establish partnerships with clinical rotation sites in rural or other underserved areas, that focus on the integration of primary care with mental health and SUD prevention and treatment services.

• Increase fellows’ knowledge and ability to assist their patients with referrals to navigate the legal and social systems related to patients’ clinical or care needs.

• Increase awareness of the specialty and reduce provider stigma to increase the number of physicians interested in pursuing careers in addiction medicine and addiction psychiatry through the provision of clinical rotations that expose medical residents to practice in these specialties and through education and consultation.

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

Step 1: Review the Opportunity 5 https://www.hrsa.gov/grants/find-funding https://www.hrsa.gov/grants/find-funding

Funding details Application Types: New

Expected total available funding in FY 2025: $23,100,000

Expected number and type of awards: 28 grants

Funding range per award: $400,000 to $800,000 per year

We plan to fund awards in five 12-month budget periods for a total 5-year period of performance of July 1, 2025 to June 30, 2030. Your request for each of the years of your project cannot exceed your year 1 request.

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

Eligibility Who can apply You can apply if your organization is a U.S.-based sponsoring institution (or parent institution of the sponsoring institution) of an accredited addiction medicine or accredited addiction psychiatry fellowship program, or a consortium (consisting of at least one domestic teaching health center and the sponsoring institution) of a domestic addiction medicine or addiction psychiatry fellowship program.

The sponsoring institution must be accredited by the Accreditation Council of Graduate Medical Education (ACGME). You must provide documentation of your ACGME accreditation in addiction medicine as Attachment 1.

Types of eligible organizations If otherwise eligible, these types of domestic* organizations may apply.

• Public institutions of higher education

• Private institutions of higher education

• Nonprofits with or without a 501(c)(3) IRS status

• For-profit organizations

• Native American tribal governments

• Native American tribal organizations

Individuals are not eligible applicants under this NOFO.

“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

Step 1: Review the Opportunity 6

Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Other eligibility criteria Trainee eligibility To receive support under this program, a trainee in an accredited AMF or APF must be one of the following:

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

• An individual lawfully admitted for permanent residence to the United States.

• Any other “qualified alien” under section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104-193, as amended.

• Fellows must be enrolled full-time (12 months) or part-time (24 months) at the sponsoring institution receiving the grant.

Project director eligibility HRSA recognizes only one project director. The program does not allow co-project directors. The project director must be a board-certified addiction medicine or addiction psychiatry physician who is employed by your organization on the date you apply.

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 all eligibility criteria.

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

• Is submitted after the deadline.

• Is not complete.

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.

If an entity applies as part of a consortium, the entity is not eligible to submit a separate, stand-alone application.

Step 1: Review the Opportunity 7

Cost sharing This program does not have a cost-sharing requirement unless your institution plans to exceed the cap on stipend payments. 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.

Match is only required, where applicable, to cover any fellow’s stipend costs beyond $110,000 per geographic reimbursement requirements set by the applicable educational institution or association. If you receive an award, you may choose to provide higher stipend amounts by including funds from other non-federal sources who must be identified in the application, and remind fellows that their stipends are considered tax-eligible income. Total project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

Program description Purpose The purpose of the AMF program is to expand the number of fellows at accredited addiction medicine and addiction psychiatry fellowship programs trained as addiction medicine specialists. These fellows will practice in medically underserved, community-based settings that integrate primary care with mental health disorder and substance use disorder (SUD) prevention and treatment services. The fellowship must include training in prevention and treatment services in medically underserved community-based settings, including in rural areas, that have limited or no access to SUD prevention or treatment. The AMF program trains both addiction medicine and addiction psychiatry fellows.

Background The United States continues to have high rates of both substance use and SUD, with over 48 million people 12 and older having a substance use disorder in 2023.[1] It is estimated that over 107,000 people died of a drug overdose in 2023, and while new data shows overdose deaths involving opioids decreasing in the past year, opioid use disorder (OUD) and associated overdose still impacts millions of people across the country. In addition to OUD, millions of people are struggling with alcohol and other substance use disorders.[2]

Access to treatment remains a challenge, as the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that only 24% of people who needed treatment in 2022 for SUD received it, leaving over 40 million people without needed

Step 1: Review the Opportunity 8 care.[3] Expanding access and reducing barriers to high quality SUD care remain necessary policy goals. Rural areas are of particular concern, with high rates of SUD, community concern surrounding SUD, and significant challenges to access. [4] [5] [6]

Stigma related to SUD contributes to access barriers. Community stigma inhibits people from seeking care[7] and increases the fear of poor treatment in care. Stigma among health care providers reduces the number of health care providers willing to provide health care services to people with SUD and has a negative impact on the quality of care they give.[8] [9] [10]

Clinicians caring for patients with SUD must also understand the implications and challenges related to Social Determinants of Health (SDoH) in diagnosis, treatment, and continuing management of patients.[11] They must be trained to make appropriate referrals and consultations with a multi-disciplinary team, including social workers and other professionals equipped to help patients address SDoH.[12] Legal referral may at times be necessary to allow for provision of high-quality care and to help patients stay in recovery. Establishment of relationships with legal-aid professionals and medical-legal partnerships (MLPs) can facilitate referral and thus contribute to care and improved patient outcomes.

Addiction medicine and addiction psychiatry specialists are board certified physicians who provide prevention, evaluation, diagnosis, and treatment services for patients with unhealthy substance use or substance-related health conditions. They provide direct clinical care and increase overall community capacity to care for patients with SUD.[13] [14] Addiction medicine fellowships prepare physicians for board certification by the American Board of Medical Specialties through advanced training pathways for both psychiatrists through Addiction Psychiatry Fellowships (APF) and for other board-certified physicians through AMFs.[15] There are approximately 100 ACGME-accredited AMF and APF programs nationwide offering programs that are typically 12 months in duration.[16] The AMF program aims to increase the number of board-certified addiction medicine and addiction psychiatry sub-specialists serving in medically underserved community-based settings, including in rural areas, over the 5-year period of performance by providing stipends for new AMF and APF slots and additional program support to sponsoring institutions.

Clinicians caring for patients with SUD must understand the implications and challenges related to the Social Determinants of Health (SDoH) in diagnosis, treatment, and continuing management of patients.[17] They must be trained to make appropriate referrals and consultations with a multi-disciplinary team, including social workers and other professionals equipped to help patients address SDoH.[18] Legal referral may at times be necessary to allow for provision of high-quality care and to help patients stay in recovery.

Step 1: Review the Opportunity 9

Program goal The goal of the AMF program is to increase the number of physicians who are board-certified addiction specialists in addiction medicine or addiction psychiatry who serve in medically underserved community-based settings, including rural areas, once trained.

Program objectives The AMF Program has 3 program objectives that will be addressed in your Standardized Work Plan (SWP):

• Increase the number of addiction medicine and addiction psychiatry sub-specialists trained to practice in medically underserved community-based settings, including rural areas, that integrate primary care with mental health and SUD prevention and treatment services.

• Increase fellows’ knowledge and ability to assist their patients with referrals to navigate the legal and social systems related to patients’ clinical needs or care.

• Increase awareness of addiction medicine as a sub-specialty and reduce provider stigma to increase the number of physicians interested in pursuing careers in addiction medicine and addiction psychiatry through the provision of clinical rotations that expose medical residents to practice in these specialties and through education and consultation.

Program requirements and expectations In your application, address how you will:

• Establish partnerships and provide support (in-kind or financial) to community-based organizations that provide clinical rotations in medically underserved settings, including in rural areas, within 6 months of your period of performance start date.

All program participants must complete at least one rural clinical rotation. View the Federal Office of Rural Health Policy definition of “rural.”

• Provide at least one of the three training tracks described in section 760(b)(1)(A)(ii) of the Public Health Services Act:

◦ A virtual training track that includes an in-person rotation at a teaching health center or in a community-based setting, followed by a virtual rotation in which the resident or fellow continues to support the care of patients at the teaching health center or in the community-based setting through the

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

Step 1: Review the Opportunity 10 https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.hrsa.gov/rural-health/about-us/what-is-rural https://www.govinfo.gov/content/pkg/COMPS-8778/pdf/COMPS-8778.pdf use of health information technology and, as appropriate, telehealth services.

◦ An in-person training track that includes a rotation, during which the resident or fellow practices at a teaching health center or in a community-based setting.

◦ An in-person training track that includes a rotation during which the fellow or resident practices in a community-based setting that specializes in the treatment of infants, children, adolescents, or pregnant or postpartum women.

• Provide fellows with interprofessional team training, including training on working with legal-aid or medical-legal partnership programs to address social and legal issues affecting a patient’s clinical condition and care.

• Provide clinical rotations that place fellows and medical residents together, giving fellows an opportunity to teach medical residents under faculty guidance. Medical residents will learn about addiction care and the specialties of addiction medicine and addiction psychiatry with a goal to recruit them into these specialties.

• Provide stigma-focused training for fellows, residents, and the community(ies) served using an interprofessional model of chronic disease.

• Provide fellows with a robust education in the SDoH as they relate to the causes, epidemiology, distribution, and treatment of SUDs, and provide training in the use of interprofessional teams to address SDoH that impact the ability to provide treatment and assist patients with maintaining their recovery.

• Respond to the need to continually adapt to a rapidly evolving field as new drugs emerge, and new treatments are developed. Describe how you will provide training that is reflective of recent advances and developments.

• Describe the experiential training that your fellows will receive in the induction and management of medications to treat SUD—including buprenorphine, methadone, and naltrexone—and the settings in which they will practice these skills.

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

• Provide information to eligible fellows about HRSA’s National Health Service Corps Loan Repayment Programs.

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

Step 1: Review the Opportunity 11 https://nhsc.hrsa.gov/loan-repayment/nhsc-all-loan-repayment-programs-comparison https://nhsc.hrsa.gov/loan-repayment/nhsc-all-loan-repayment-programs-comparison

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.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting the project’s objectives.

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

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.

Maintenance of effort Federal funds must add to any existing non-federal funds for your proposed activities. If you receive an award, you must spend at least as much on proposed activities as you spent in the last fiscal year before the award—42 U.S.C. § 295n-2(b) (Public Health Service Act section 797(b)) requires this. We will enforce this statutory requirement through all available mechanisms. You must provide supporting documentation in Attachment 5.

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 R&R 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.

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

Step 1: Review the Opportunity 12 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=15 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75#p-75.216(b)

Program-specific statutory or regulatory limitations

• 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 to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on use of funds for lobbying, executive salaries, gun control, abortion, etc. The efficacy of these policies, procedures and financial controls is subject to audit.

• Anyone who receives federal funding must comply with legal requirements and restrictions, including those that limit specific uses of funding.

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

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.

Per 45 CFR 75.414, indirect costs for training awards cannot exceed 8 percent of modified total direct costs.

For modified total direct costs, we use the definition at 2 CFR 200.1. MTDC means all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $50,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs and with the approval of the cognizant agency for indirect costs.

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 13 https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-45/section-75.414 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 15

Find the application package 15

Application writing help 15

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.

Need Help? See Contacts and 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-25-069.

After you select the opportunity, we recommend that 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.

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

Step 2: Get Ready to Apply 15 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

Join the webinar We will hold a pre-application technical assistance (TA) webinar. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website to learn more about the resources available for this funding opportunity.

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

Step 2: Get Ready to Apply 16 https://bhw.hrsa.gov/fundingopportunities/default.aspx https://bhw.hrsa.gov/fundingopportunities/default.aspx

Step 3:

Prepare Your Application

In this step

Application contents and format 18

Application contents and format Applications include 5 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 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 Other Attachments form. Yes, unless otherwise marked below.

Other required forms Upload using each required form. Indicated in the other required forms section.

See the application checklist for a full list of all application requirements. See form instructions for more detail on completing each 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 R&R 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. When applicable,

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

Step 3: Prepare Your Application 18 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=25 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=25 identify if you are requesting a funding priority or preference. For more information, see section 3.1.2 of the R&R Application Guide.

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

Use the following section headers in the order shown.

Introduction and purpose See merit review criterion 1: Purpose and need

• Briefly describe the purpose of your project.

Need See merit review criterion 1: Purpose and need

• Briefly describe the community and population served by your institution and the need for SUD prevention and treatment services.

• Provide information on substance use and SUD; existing services; and gaps in access, supply, quality, and distribution of services in your community and other communities served by the clinical rotation sites.

• Use and cite demographic data as part of the descriptions and explanations above, whenever possible.

Approach See merit review criterion 2: Response

• Tell us how you will address your stated needs and meet the program requirements and expectations described in this NOFO.

• Describe how you will deliver experiential clinical training that develops competencies in integrated, interprofessional team-based care, focused on at risk populations for OUD and other SUD prevention, treatment, and recovery services, including medication.

• Describe how you will work with medically underserved community-based sites, including in rural areas, to assure adequate supervision and logistical support for fellowship rotations.

• Describe your approach to addressing and reducing stigma among fellows, residents, and community(ies) served.

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

Step 3: Prepare Your Application 19 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=1

• Describe how you will educate fellows regarding SDoH and the role of interprofessional and medical-legal teams in addressing SDoH that affect treatment and recovery.

• Explain your strategies to improve fellows’ cultural competence to meet the needs of medically underserved communities, including in rural areas. Include those that increase the use of culturally and linguistically appropriate services by providing training based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards.

High-level work plan See merit review criterion 2: Response

• Describe how you will achieve the goal of the AMF program and each of the three objectives, and how you will meet the program requirements and expectations identified in this NOFO during the period of performance.

• Include a more detailed work plan in your Standardized Work Plan (SWP). See other required forms. One sub-objective of each year’s main objective must be a numerical target for the number of fellows above the pre-grant baseline you intend to train in that budget year and must align with the number of fellows to be trained in Attachment 8.

• Describe how the Program Director (PD) will devote at least 20 percent of their time to the project.

• Provide a timeline—by budget year and by quarter—in the SWP that includes each program objective and identifies who is responsible for each by their title, rather than name. As needed, identify how key personnel and stakeholders will help plan, design, and carry out all activities to accomplish each program objective.

• Provide in Attachment 9: the clinical rotation sites in which the fellows will train;

length of rotation; identify if site is rural or medically underserved; and the type of training track per program requirements.

• Describe how you will collaborate with clinical sites to identify and secure clinical rotation site training.

• Describe your plan to educate fellows, residents, and the community(ies) served to address stigma.

Resolution of Challenges See merit review criterion 2: Response

Discuss challenges that you are likely to encounter in designing and carrying out the activities in the work plan. Explain approaches that you will use to resolve them. You

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

Step 3: Prepare Your Application 20 https://thinkculturalhealth.hhs.gov/clas may include other challenges not noted here, but you should speak specifically to the following challenges:

• Recruitment of fellows and faculty to your program.

• Identifying clinical rotation sites in medically underserved community-based settings, including in rural areas.

• Supervision and support of fellows at clinical rotation sites.

• Challenges in training fellows, residents, and community(ies) served on stigma.

Performance reporting and evaluation See merit review criteria 3: Impact and 4: Resources and capabilities

• Outcomes. Describe the expected outcomes (desired results) of the funded activities. Include:

◦ How many fellows (both HRSA funded and in total) you intend to train per year and over the period of performance.

◦ How many residents will participate in rotations supervised by AMF fellows.

◦ How you will expand SUD services and expand access to those services.

◦ How you will impact SUD morbidity and other effects of untreated mental health and SUD in your community.

• Performance Measurement and Reporting. See Report on Your Grant for performance measure requirements and examples of reporting forms.

◦ Describe how you will accurately and timely collect and report required performance data.

◦ Describe how you will manage and securely store data.

▪ Include how you will report National Provider Identifier (NPI) numbers for participants. Project trainees in eligible disciplines must apply for, and report on, an NPI.

◦ Describe your process to track fellows for up to 1 year after program completion, including collecting fellows’ NPI numbers.

◦ Provide a continuous quality improvement plan to collect, analyze, and manage data and monitor project results to ensure accurate and timely performance.

• Program Evaluation. The evaluation should examine processes and progress towards the AMF program goal, objectives, and expected outcomes. Evaluations must follow the HHS Evaluation Policy, as well as the standards and best practices described in OMB Memorandum M-20-12. Describe your plan to evaluate the project. Include:

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

Step 3: Prepare Your Application 21 https://grants4.hrsa.gov/WebBPMHExternal/Interface/ProgramManualHTML.aspx?FormCode=1&IsPM=False&EHBActivityCode=T25 https://aspe.hhs.gov/reports/department-health-human-services-evaluation-policy https://www.whitehouse.gov/wp-content/uploads/2020/03/M-20-12.pdf

◦ The evaluation questions, methods, data to be collected, and timeline for implementation.

◦ The evaluation barriers and your plan to address them.

◦ The evaluation capacity of your organization and staff. Include experience, skills, and knowledge.

◦ How you will disseminate results, 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 criterion 3: Impact

We expect you to sustain key project elements that 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’ll 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 that you’ll likely encounter in sustaining the program. Include how you will resolve these challenges.

Organizational information See merit review criterion 4: Resources and 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 in Attachment 2.

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

• Describe how you’ll assess the unique needs of the fellows and residents you serve.

• Describe the organizations you will partner with to fulfill the program goals and meet the training objectives. Include key agreements in Attachment 3 and letters of support in Attachment 10.

Step 3: Prepare Your Application 22

• Include a staffing plan and job descriptions for key faculty and staff in Attachment 4.

• Include biographical sketches for key staff using the Research and Related Senior/ Key Person Profile form. See other required forms.

Budget and budget narrative See merit review criterion 5: Support requested

Your budget should follow the instructions in section 3.1.4 of the R&R Application Guide and any specific instructions listed in this section.

HHS now uses the definitions for equipment and supplies in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

Reminder: Indirect costs for training awards cannot exceed 8% of modified total direct costs. The total project or program costs are all allowable (direct and indirect) costs incurred for the HRSA award activity or project. This includes costs charged to the award and non-federal funds used to satisfy any matching or cost sharing requirement (which may include maintenance of effort, if applicable).

The budget narrative supports the information you provide in the Research and Related Budget Form. See other required forms. Your budget should show a well-organized plan. The merit review committee reviews both.

The budget narrative includes an itemized breakdown and a clear justification of the requested costs. As you develop your budget, consider:

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

• The restrictions on spending funds. See funding policies and limitations.

To create your budget narrative, see detailed instructions in section 3.1.5 of the R&R Application Guide. Follow these additional instructions specific to this NOFO follow.

Administration and program management The project director should dedicate at least 20% of their time to grant activities and can be funded either through in-kind contributions or grant funds. Co-project directors are not an allowable cost.

Over the 5-year period of performance, up to 50% of total funding can be used for program operations and management or other recipient activities. This may include project staff salaries and fringe benefits, faculty development, conferences, travel

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/research-related-application-guide.pdf#page=22 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=22 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Supplies) https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=33 https://www.hrsa.gov/sites/default/files/hrsa/grants/research-related-application-guide.pdf#page=33 related expenses, indirect costs, and other applicable program support costs. The remaining 50% of funds (or greater) must be spent on stipends for fellows.

Accreditation costs of any kind—such as renewals, annual, and other fees—are not allowable under this program.

Grant funds cannot be used to pay for legal services for patients, or for costs incurred by the legal entity that is part of the MLP.

Fellow stipends You may use up to $110,000 of AMF funds annually for stipends for each fellow. You may choose to provide higher stipend amounts by including funds from other non-federal sources to cover any greater geographic reimbursement requirements set by the applicable educational program or institution. You will need to identify what non-federal source will be providing supplemental funds in the budget justification. Include a disbursement plan for the stipends which includes a point of contact and schedule of disbursement (such as monthly or quarterly).

• Total funding requested per year can be no more than the following:

◦ $400,000 per year to train up to 2 full time equivalent (FTE) fellows.

◦ $600,000 per year to train 3 or 4 FTE fellows.

◦ $800,000 per year to train 5 or more FTE fellows.

• No less than 50% of the total funding over the 5-year period of performance must be dedicated to stipends for fellows. Up to 50% of total funding can be used for the program operations and management or other recipient activities.

• Funding for fellow stipends cannot be used for fellowship positions already funded from non-HRSA funded sources.

• No more than $110,000 of grant funding per year, per fellow, can be awarded for a full-time stipend. No more than 12 months of stipend support is allowed per full-time fellow.

• Part-time fellows may receive a stipend prorated at $55,000 per year for no more than 24 months, for a total of $110,000 per part-time fellow.

• Stipends are subsistence allowances for fellows to help defray living expenses during the training experience and are not provided as a condition of employment.

• Grant recipients may not offset the amount of stipends for tuition, health insurance, or other costs associated with the training program. These items may be included in Participant support costs.

• Liability insurance, unemployment insurance, life insurance, taxes, fees, retirement plans, or other fringe benefits for fellows are unallowable costs.

Step 3: Prepare Your Application 24

• Health insurance for fellows is an allowable participant support cost as an administration/program support cost.

Participant support costs If you include participant support costs for fellows:

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

• Identify the number of fellows.

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

• Include a subtotal entitled “Total Participant Support Costs” with the summary of these costs.

Preceptor/Faculty costs Preceptors can be either your employee or contractor. Preceptor costs are unique and different than participant costs, which are for your students. Allowable preceptor costs may include:

• Continuing percent of salary (for employees) education, other trainings, and related fees

• Stipends (other than to employees)

• Travel

• If the preceptor is an employee, specify those costs under section B. Other Personnel, Section D Travel and Section F Other Direct Costs.

• If the preceptor is a contractor, lists those costs under Section F: Other Direct Costs.

• Include the number of preceptors in your budget narrative.

Note: You cannot require students to pay for preceptor costs.

Consultant services In the budget justification, identify each consultant, the services they will perform, the total number of days, travel costs, and the total estimated costs.

Attachments Place your PDF attachments in order in the Attachments form.

Attachment 1: Accreditation documentation Required- Counts toward page limit.

Step 3: Prepare Your Application 25

You must provide documentation of your ACGME accreditation as an Addiction Medicine or Addiction Psychiatry Fellowship. You must provide:

• A statement that you hold an initial or continuing accreditation from the ACGME and are not on probation.

• A copy of the document of accreditation.

• The accreditation start and expiration dates.

Please do not provide only the web link to the accreditation body’s website. HRSA will not open any links included in the application.

Attachment 2: Project organizational chart Required- Counts toward page limit.

Provide a one-page diagram that shows the full project’s organizational structure.

Include all aspects, not just for your organization.

Attachment 3: Letters of agreement, memoranda of understanding, and contracts As applicable- Counts toward page limit.

Provide any documents that describe working relationships between your organization and other organizations and programs you cite in the proposal. Documents that confirm actual or pending contractual or other agreements should clearly describe the roles of the contractors and partners and any deliverables. Make sure any letters of agreement are signed and dated.

Attachment 4: Staffing plan and job descriptions Required- Counts toward page limit.

See Section 3.1.7 of the R&R Application Guide. Include a staffing plan that shows staff positions that will support the project and key information about each. Justify your staffing choices, including education and experience qualifications, and your reasons for the amount of time you request for each staff position.

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

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

Step 3: Prepare Your Application 26

Attachment 5: Maintenance of effort documentation Required- Counts toward page limit.

Specify the non-federal funds that support proposed activities. These include cash, in-kind, or other contributions. Do not include any federal funds. See Maintenance of Effort requirement.

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

FY before application:

Actual non-federal expenditures

First FY of award:

Estimated non-federal expenditures

Attachment 6: Funding priority documentation As applicable- Counts toward page limit.

Provide documents that prove you qualify for the funding priority as authorized by section 760(d)(1) of the Public Health Service Act.

See Selection Process for information about how these apply.

Attachment 7: Funding preference documentation As applicable- Counts toward page limit.

funding preference See Selection Process for information about how these apply.

Attachment 8: Fellow training table Required- Counts toward page limit.

Provide the number of fellows who will be enrolled in your program using the following table. Include:

• The total number of ACGME approved positions.

• The total number of fellows enrolled in academic year (AY) 2024

• The total number of fellows in your AMF or APF grant program by year.

• The total number of HRSA-funded fellows by year.

• The total number expected to complete their fellowship by year.

• The total number of HRSA-funded fellows intended to complete fellowship by year.

Step 3: Prepare Your Application 27

Table: Fellow Training Table

Total number of

ACGME

approved positions

Number of fellows enrolled in AY 2024

Grant year Total number of fellows in your program

Total number of HRSA- funded fellows (intended)

Total number of fellows expected to complete fellowship

Year 1

Year 2

Year 3

Year 4

Year 5

Total

Attachment 9: Clinical rotation sites table Required- Counts toward page limit.

You must provide documentation of the clinical rotation sites offered using the following table. Include:

• The name of the clinical rotation site.

• The full address of the clinical rotation site, including physical street address, town, state, and extended ZIP Code.

• Whether the clinical rotation site is located in a rural area as defined by the Federal Office of Rural Health Policy using the Rural Health Grants Eligibility Analyzer.

• Whether the clinical rotation site serves a designated shortage area if it is located in a Health Professional Shortage Area, Medically Underserved Area, or serves a Medically Underserved Population as defined in the designated shortage area tool.

• The length of the clinical rotation in months.

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

Step 3: Prepare Your Application 28 https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/shortage-area/by-address https://data.hrsa.gov/tools/shortage-area/by-address

• The academic years (AY) of the clinical rotations.

• The number of fellows expected to be trained by year.

Table: Clinical rotation site table

Name of clinical rotation site

Full physical address

Type of training (inpatient, outpatient, OTP, etc.)

Located in rural area?

(yes or no)

Located in designated shortage area?

(yes or no)

Length of clinical rotation

(months)

Academic year

Number of fellows to be trained

(by year)

Add additional rows as needed.

Attachment 10: Letters of support As applicable- Counts toward the page limit.

You may provide letters of support from organizations or departments involved in the proposed project.

Letters of support can also be from individuals within your institution who hold the authority to speak for the organization or department such as a CEO or chair.

Recommenders should indicate an understanding of and commitment to the project.

Recommenders should sign and date their letter of support.

Attachments 11 to 15: Other relevant documents As applicable- Counts toward the page limit.

You may submit other documents as you deem necessary in support of your application. Note that any elective attachments will count in the page limit.

Other required standard forms You will need to complete some other forms. Upload the forms listed below at Grants.gov. You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms. See the application checklist for a full list of all application requirements.

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

Step 3: Prepare Your Application 29 https://www.grants.gov/forms

Forms Submission Requirement

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

Yes, with application.

Research and Related Other Project Information

Yes, with application.

Standardized Work Plan (SWP) form Yes, with application.

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

Yes, with application.

Research and Related Budget form Yes, with application.

R&R Subaward Budget Attachment(s) Form Yes for any subawards proposed, with application.

Project/Performance Site Locations(s) form Yes, with application.

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

Form instructions SF-424 R&R form Does not count toward the page limit.

Follow the instructions for Application for Federal Assistance in section 3.1.1 of the R&R Application Guide.

Research…