oppHRSA-18-013-cfda93.884-cidHRSA-18-013-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Primary Care Training and Enhancement: Training Primary Care Champions

Funding Opportunity Number: HRSA-18-013 Funding Opportunity Type: Initial: New

Catalog of Federal Domestic Assistance (CFDA) Number 93.884

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: January 30, 2018

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

Deadline extensions are not granted for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to one month to complete.

Issuance Date: November 13, 2017

Anthony Anyanwu, MD, MHA, MSc Project Officer Division of Medicine and Dentistry Telephone: 301-443-8437 Fax: 301-443-0162 Email: aanyanwu@hrsa.gov

Authority: Section 747(a) of the Public Health Service (PHS) Act (42.U.S.C. 293k(a)) http://www.ecfr.gov/cgi-bin/retrieveECFR

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Bureau of Health Workforce, Division of Medicine and Dentistry is accepting applications for the fiscal year (FY) 2018 Primary Care Training and Enhancement (PCTE): Training Primary Care Champions program. The purpose of this program is to strengthen primary care and the workforce by establishing fellowship programs to train community-based practicing primary care physician and/or physician assistant champions to lead health care transformation and enhance teaching in community–based settings. The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner.

Applicants should note that this program may be cancelled prior to award recommendations.

Funding Opportunity Title: Primary Care Training and Enhancement:

Training Primary Care Champions Funding Opportunity Number: HRSA-18-013 Due Date for Applications: January 30, 2018

Anticipated Total Annual Available FY18 Funding:

$4,000,000

Estimated Number and Type of Award(s): Up to 10 grants Estimated Award Amount: Up to $400,000 per year Cost Sharing/Match Required: No Project Period/Period of Performance: September 1, 2018 through August 31, 2023 (5 years) Eligible Applicants: Eligible applicants must be accredited schools of allopathic or osteopathic medicine, academically affiliated physician assistant training programs, accredited public or nonprofit private hospitals, or a public or nonprofit private entity that the Secretary has determined is capable of carrying out such grants.

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise. A short video for applicants explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

Technical Assistance

The following technical assistance webinar and conference call have been scheduled:

Webinar #1

Day and Date: Tuesday, November 28, 2017 Time: 2:00 to 3:30 p.m. ET Call-In Number: 1-888-972-6410 Participant Code: 8968481 Web link: https://hrsa.connectsolutions.com/fy18pctenofo/

TA session #2 Conference Call - Frequently Asked Questions

Day and Date: Monday, December 18, 2017 Time: 2:00 pm to 3:30 p.m. ET Conference Number: 1-888-972-6410 Participant Passcode: 8968481 Playback Number: 1-866-475-8046 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number and System for Award Management

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Primary Care Training and Enhancement (PCTE): Training Primary Care Champions program authorized by Section 747(a) of the Public Health Service (PHS) Act (42.U.S.C. 293k(a.)

Program Purpose

The purpose of this program is to strengthen primary care and the workforce by establishing fellowship programs to train community-based practicing primary care physician and/or physician assistant champions to lead health care transformation and enhance teaching in community-based settings. Characteristics of transformed health care delivery systems identified by the Centers for Medicare and Medicaid Services (CMS) include:

• Providers across the care continuum participate in integrated or virtually integrated delivery models,

• Care is coordinated across all providers and settings,

• High level of patient engagement and quantifiable results on patient experience,

• Providers leverage the use of health information technology to improve quality,

• Providers perform at the top of their license and board certification,

• Population health measures are integrated into the delivery system, and

• Data are used to drive health system processes.1

HRSA also recognizes addressing social determinants of health as a characteristic of transformed health care delivery systems.

Program Requirements

In FY 2018, applicants for the PCTE: Training Primary Care Champions program must develop academic-community partnerships to train and support primary care physician and/or physician assistant champions to lead health care transformation in community-based settings and enhance teaching in community-based settings.

The applicant organization must include or partner with the following organizations:

1. An academic medical school or physician assistant school; and

2. One or more community-based primary care sites. Applicants are encouraged to partner with National Health Service Corps-approved sites. Sites also can be health centers, rural health clinics, and Indian Health Service sites.

If the applicant organization is a medical school or physician assistant school they are not required to partner with another medical school or physician assistant school.

1 CMS State Innovation Models Cooperative Agreement Announcement (May 2014). Available at:

http://innovation.cms.gov/Files/x/StateInnovationRdTwoFOA.pdf

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Applicants must identify community-based primary care partners at the time of application, and are expected to expand these partnerships over the 5-year grant period. For example, the applicant may add partnerships with additional community health centers, other community-based primary care organizations, or other sites in the second , third, fourth, and fifth years of the project. They would then be able to recruit Fellows from the additional partner sites.

HRSA also encourages partnerships with other health and community-based organizations, including local departments of health, Department of Veterans Affairs medical facilities, Area Health Education Centers, AIDS Education and Training Centers, and Public Health Training Centers.

Applicants must develop and operate a program for the training of physicians and physician assistants who will teach in community-based settings and provide training in new competencies, consistent with health care transformation principles. Applicants may provide financial assistance in the form of fellowships to the participants of these programs. Applicants must:

1. Develop and implement these fellowship programs through academic-community partnerships. Community-based primary care sites must be committed to identifying and supporting physicians and/or physician assistants from their organizations to participate in the PCTE: Training Primary Care Champions program. Fellows must continue to provide clinical services at the primary care site through the course of the fellowship program. Understanding of and commitment to these requirements should be delineated in a letter of agreement from each partnering primary care site (see Attachment 2).

2. Train fellows in the areas of leadership, health care transformation, and education. Training must include content to address competencies in the areas of leadership,2 team-based integrated health care, quality improvement, population health, social determinants of health, health policy, and education.3

3. Support fellows in the selection and implementation of a health care transformation project in their community-based primary care site. These projects must match the needs of the primary care site, have clearly defined goals, objectives, and expected outcomes, and have clear evaluation plans to determine the impact of these projects on improving health among the community served by the primary care site. Fellows must receive appropriate mentorship and support for these projects, and evaluation outcomes should be matched to relevant quality outcomes, for example Uniform Data Systems (UDS) quality outcomes for Health Centers and CMS Clinical Quality Measures for EHR Incentive Programs quality measures.

2 Examples of relevant leadership competencies can be found (but not limited to) at:

• http://www.ahaphysicianforum.org/files/pdf/LeadershipEducation.pdf

• http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_

Leadership.pdf 3 Examples of relevant education competencies can be found (but not limited to) at:

• https://www.stfm.org/fmhub/fm2007/May/Dona343.pdf http://bphc.hrsa.gov/qualityimprovement/performancemeasures/index.html http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Eligible-Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Eligible-Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf http://www.ahaphysicianforum.org/files/pdf/LeadershipEducation.pdf http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_Leadership.pdf http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_Leadership.pdf https://www.stfm.org/fmhub/fm2007/May/Dona343.pdf

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The fellowship training program must be at least one year and not longer than two years. The minimum number of fellows per training period is four physicians or physician assistants for one-year programs and eight for two-year programs. HRSA will convene grant recipients and fellows annually for an in-person meeting; applicants should include the cost of this travel in their budget request.

Applicants are encouraged to address the Department of Health and Human Services (HHS) clinical priorities of opioid abuse, mental health, and childhood obesity through their training and fellows’ health care transformation projects.

Applicants should be committed to increasing the diversity of the health workforce. This commitment helps to ensure, to the extent possible, that the workforce addresses the diversity of the Nation. Training programs should develop the competencies and skills needed for intercultural understanding and expanded cultural fluency, recognizing that bringing people of diverse backgrounds and experiences together facilitates innovative and strategic practices that enhance the health of all people.

Additional Program Information

The PCTE program is partnering with the National Health Service Corps (NHSC), per the recommendation of the Advisory Committee on Training in Primary Care Medicine and Dentistry “to leverage funding streams to reduce barriers and foster programmatic collaboration.”4 The NHSC Loan Repayment Program (LRP) is authorized under section 338B of the Public Health Service (PHS) Act (42 U.S.C. § 2541-1) to provide loan repayment assistance to primary health care professionals in exchange for a commitment to serve in a Health Professional Shortage Area (HPSA).

The NHSC is committed to strengthening the primary care workforce through the recruitment and retention of high quality primary care providers at NHSC-approved sites. Studies show that Title VII funding of departments of family medicine at U.S.

medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. 5 For example, a recent study found that physicians who have trained in Title VII-funded programs are more likely to work with the underserved in community health center and NHSC sites than those who do not. 6

Acknowledging the importance of these Title VII programs, and their impact on the preparation and training of health professionals that serve in underserved areas, HRSA designed the PCTE: Training Primary Care Champion program to give PCTE fellows experience and competency in areas that make them more likely to serve in underserved areas. Therefore, HRSA intends to provide physicians and physician assistants who have completed PCTE fellowships with priority status when applying for

4 Advisory Committee on Training in Primary Care Medicine and Dentistry. Training Health Professionals in Community Settings During a Time of Transformation: Building and Learning in Integrated Systems of Care.

December, 2014.

5 Meyers, D., Fryer G., Krol, D., Phillips R., Green L., & Dovey, S. (2002). Title VII funding is associated with more family physicians and more physicians serving the underserved. American Family Physician, 66(4), 554.

6 Harrison, B., Rittenhouse, D., Phillips R., Grumbach, K., Bazemore, A., & Dodoo, M.

(2010). Title VII Is critical to the community health center and national health service corps Workforce. American Family Physician, 81(2), 132. Retrieved from http://www.aafp.org/afp/2010/0115/p132.html#afp20100115p132-f1

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NHSC LRP awards and continuation awards consistent with PHS Act section 338B(d)(2)(B), which provides a priority to NHSC LRP applicants who have “characteristics that increase the probability that the individual will continue to serve in a health professional shortage area after the period of obligated service …is completed.”

Participants in the NHSC LRP, NHSC Scholarship Program (SP), and NHSC Students to Service (S2S) LRP interested in participating in a PCTE primary care leadership fellowship program may convert to a half-time contract and continue satisfying their service obligation.

Funding Preference

This notice includes a funding preference (section 791(a)(1) of the PHS Act). The funding preference is for applicants that:

a) demonstrate a high rate for placing graduates in practice settings having the principal focus of serving residents of Medically Underserved Communities or demonstrate a significant increase in the rate of placing graduates in Medically Underserved Communities settings over the preceding two years; or

b) are new programs as defined by PHS Act section 791(c).

In order to receive the funding preference, applicants must clearly indicate the funding preference for which they are applying in the Abstract as well as the school and discipline they are applying for (i.e., medical or physician assistant school), provide all required information, and meet the designated targets. Applicants may apply for this notice of funding opportunity without requesting a funding preference; applicants receiving a funding preference will be placed in a more competitive position among applications that can be funded. Refer to Section V.2 of this NOFO for detailed information on qualifying for a funding preference. Requested information to apply for the funding preference must be submitted in Attachment 6.

2. Background

This program is authorized by Title VII of the Public Health Service Act, Section 747(a) (42.U.S.C. 293k(a)). The focus of this authority is on improving the Nation’s access to well-trained primary care physicians and physician assistants by supporting enhanced primary care training for physician and physician assistant students, residents, faculty, and practicing providers.

Research shows that a strong primary care foundation is critical for health care system performance and improved health.7,8 Recent evidence also suggests that expanding primary care workforce and availability of primary care services is associated with

7 Starfield B, Shi l, Macinko J. Contributions of primary care to health systems and health. Millbank Quarterly 2005;83:457-502.

8 Chang C, Stukel TA, Flood AB, Goodman DC. Primary care physician workforce and Medicare beneficiaries’ health outcomes. JAMA. 2011;305(20):2096-2104.

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higher quality care at lower spending.9 Despite this evidence, the U.S. primary care workforce shortages limit access to high quality health care for the Nation. The demand for primary care services is projected to increase largely due to population aging and growth. However, increases in supply are not expected to meet the increases in demands for primary care providers, and shortages are magnified for underserved communities.10 Substantial disparities exist in the distribution of primary care providers, and shortages of health care providers impact rural areas disproportionately.11

Evidence suggests that a number of strategies are effective in promoting primary care and rural and underserved career choices. Role model, health professional school culture, and positive training experiences in rural and underserved communities can drive primary care career choices, as well as practice location.12,13 Medical schools where students report positive experiences in primary care increased the likelihood of practicing primary care. In contrast, students who attended schools with high levels of negative reinforcement for primary care were less likely to practice in primary care.

In order to have positive role models, cultural changes, and community-based training, it is necessary to support and develop future community-based primary care physician and physician assistant champions. Calls for transformed health care systems to achieve the vision of patient-centered primary care also highlight the need for champions – particularly primary care leaders.14,15 Primary care leadership requires training and support in specific knowledge and skills. Programs to develop primary care leaders for underserved practice have demonstrated early success in retaining individuals in community health, placing individuals into leadership positions, and positioning individuals to obtain grants to support ongoing projects.16 Graduates from these programs have also reported benefits for community-based teaching and preceptors as a result of these programs, including increased financial support, faculty development for community preceptors, and enhanced community-based curriculum for students. 17

9 Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care.

Health Affairs. 2004. Available at:

http://content.healthaffairs.org/content/early/2004/04/07/hlthaff.w4.184.full.pdf+html.

10 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Projecting the Supply and Demand for Primary Care Practitioners Through 2020. Rockville, Maryland: U.S. Department of Health and Human Services, 2013.

11 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas. Available at:

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/nchwafactsheet.pdf 12 Connelly MT, et al. Variation in Predictors of Primary Care Career Choice by Year and Stage of Training. JGIM. 2003; 18(3):159-69.

13 Goodfellow A, et al. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Acad Med. 2016; 91(9):1313-21.

14 Davis, K, et al. A 2020 Vision of Patient-Centered Primary Care. JGIM. 2005; 20(10): 953-7.

15 Markuns, J, et al. Commentary: A Need for Leadership in Primary Health Care for the Underserved: A Call to Action. Academic Medicine. 2009; 84(10): 1325-7.

16 Shtasel, D., Hobbs-Knutson, K., Tolpin H., Weinstein, D., Gottlieb, G., Developing a Pipeline for the Community-Based Primary Care Workforce and Its Leadership: The Kraft Center for Community Health Leadership’s Fellowship and Practitioner Programs. Academic Medicine. 2015; 90(9): 1272-1277.

17 DeWitt, T, Cheng, T. The Role of Title VII Funding in Academic General Pediatrics Fellowships and Leadership. Academic Medicine. 2008; 83(11): 1103-6.

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The goal of the PCTE: Training Primary Care Champions program is to train community-based primary care champions to lead health care transformation, enhance recruitment and retention in community-based settings, and grow academic-community partnerships to support enhanced teaching in community-based settings.

Program Definitions The following definitions apply to the PCTE: Training Primary Care Champions program for FY 2018.

Accredited – a hospital, school, or program, officially recognized by a national body or state agency, and approved by the Secretary of Education. In general, the relevant accrediting bodies are the Liaison Committee on Medical Education (LCME) for allopathic medical schools, the American Osteopathic Association (AOA) for osteopathic medical schools, and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for physician assistant programs. A new school or program that is not eligible for accreditation when they apply for a grant/contract, due to an insufficient period of operation can become accredited by the Secretary of Education. The Secretary must be reasonably assured that the program will meet the accreditation standards prior to the beginning of the academic year following the normal graduation date of students of the first entering class in such a school or program.

Diversity – a multiplicity of human differences among groups of people or individuals.

To increase diversity is to enhance an individual/group/organization’s cultural competence—the ability to recognize, understand, and respect the differences that may exist between groups and individuals. Increasing diversity in the health care workforce requires recognition of many other dimensions, e.g. sex, sexual orientation and gender identity, race, ethnicity, nationality, religion, age, cultural background, socio-economic status, disability, and language.

Fellowship – a training program that provides an individual or group of individuals (known as “fellows”) with advanced training in a general content area. Fellows generally receive a financial award to help defray costs associated with advanced training (also referred to as a “fellowship”).

Medically Underserved Communities (MUC) - a geographic location or population of individuals that is eligible for designation by a state and/or the federal government as a health professions shortage area (HPSA), medically underserved area (MUA), and/or medically underserved population (MUP). These communities have limited access to primary health care services. The term MUC is an umbrella term that can be used to describe any location that meets one or more of the previously identified designations.

Primary Care Setting – For the purpose of this NOFO, a primary care setting is “one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, and hospices are not considered primary care settings

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under this definition.” Note: NHSC participants must continue to meet the service site requirements established under the NHSC program.

Social Determinants of Health - the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce can be located at the Health Workforce Glossary.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

Funding will be provided in the form of a grant.

2. Summary of Funding

Approximately $4,000,000 is expected to be available annually to fund up to 10 awards.

Applicants may apply for a ceiling amount of up to $400,000 total cost (includes both direct and indirect, facilities, and administrative costs) per year. The actual amount available will not be determined until enactment of the final FY 2018 Federal appropriation. The FY 2018 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds can be awarded in a timely manner.

The project period is September 1, 2018 through August 31, 2023 (5 years). Funding beyond the first year is dependent on the availability of appropriated funds for the PCTE: Training Primary Care Champions program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

Indirect costs under training awards to organizations other than state, local, or Indian tribal governments will be budgeted and reimbursed at eight (8) percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment and capital expenditures, tuition and fees, and sub-awards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

https://bhw.hrsa.gov/grants/resourcecenter/glossary http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants must be accredited schools of allopathic or osteopathic medicine, academically affiliated physician assistant training programs, accredited public or nonprofit private hospitals, or a public or nonprofit private entity that the Secretary has determined is capable of carrying out such grants. Faith-based and community-based organizations, tribes and tribal organizations may apply for these funds, if otherwise eligible.

The applicant must submit accreditation documentation for the medical or physician assistant school partner(s) in Attachment 7.

Required Accreditation Documentation The applicant organization must provide:

(1) a statement that the medical or physician assistant school holds continuing accreditation from the relevant accrediting body and is not on probation,

(2) the name of the accrediting body,

(3) the date of initial accreditation, or provisional accreditation or evidence that they have started the accreditation process from the accreditation agency and

(4) the date of the next expected accrediting body review (or expiration date of current accreditation). The full letter of accreditation is not required. Award recipients must immediately inform the HRSA project officer of any change in accreditation status.

HRSA staff will verify this information. Information that cannot be verified and applications that do not include the required accreditation documentation as specified in this NOFO will be considered non-responsive and will not be considered for funding under this notice.

If a partner organization holds the accreditation for a training program, a letter of agreement must be provided in Attachment 2.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount Applications that exceed the ceiling amount of $400,000 total cost per year will be considered non-responsive and will not be considered for funding under this notice.

Deadline Any application that fails to satisfy the deadline requirements referenced in Section IV.4 will be considered non-responsive and will not be considered for funding under this notice.

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Maintenance of Effort (MoE) The recipient must agree to maintain non-Federal funding for award activities at a level which is not less than expenditures for such activities during the fiscal year prior to receiving the award as required by Section 797(b) of the Public Health Service Act.

Complete the Maintenance of Effort document and submit as Attachment 5.

Multiple Applications

NOTE: Multiple applications from an organization are not allowable. Separate organizations are those entities that have unique DUNS numbers.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

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

Every trainee receiving support from award funds must be a citizen of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov. You must download the SF-424 Research and Related (R&R) application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

Effective December 31, 2017 - You must use the Grants.gov Workspace to complete the workspace forms and submit your application workspace package. After this date, you will no longer be able to use PDF Application Packages.

HRSA recommends that you supply an email address to Grants.gov on the Grant Opportunity Synopsis page and when accessing the NOFO (also known as “Instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html

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2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise.

Applications must be submitted in the English language and must be in terms of U.S.

dollars (45 CFR § 75.111(a)).

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 65 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the application package do NOT count in the page limitation. Biographical Sketches do count in the page limitation. The Indirect Cost Rate Agreement and proof of non-profit status (if applicable) will not be counted in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

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

3) Where the prospective recipient is unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 10: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole,

2. Specific, measurable objectives that the project will accomplish,

3. How the proposed project will be accomplished, i.e., the "who, what, when, where, why and how" of a project, including the length of the proposed training program (e.g. 1 or 2 years), and

4. A clear statement about which Funding Preference is being requested as well as the school and discipline being applied for, if applicable. Justification is to be provided in Attachment 6.

ii. Project Narrative

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

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

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

First, briefly describe the purpose of the proposed project consistent with the program requirements in the NOFO. Describe the current need for primary care physician and physician assistant champions in your community, any challenges faced in the recruitment and retention of these individuals, and any gaps in the current training and support for primary care providers.

Second, clearly describe the partnering community-based primary care sites and the populations and communities served by these sites, particularly any vulnerable populations served, including rural, underserved, and veterans. Describe the demographics, social determinants of health, and health disparities impacting the population or communities served. Clearly indicate if any of these sites are NHSC-approved. You can confirm if a site is NHSC-approved by using the Health Workforce Connector. Use and cite demographic data whenever possible to support the information provided.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections

— (a) Methodology/Approach; (b) Work Plan; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

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

#2 (a).

https://connector.hrsa.gov/ https://connector.hrsa.gov/

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You must describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Proposed methods must meet the program requirements described in this NOFO: Describe how the fellowship program will train the individuals to teach in their primary care setting and serve as leaders in primary care and healthcare transformation.

1. Develop and implement these fellowship programs through academic-community partnerships. Community-based primary care sites must be committed to identifying and supporting physicians and/ or physician assistants from their organizations to participate in the PCTE: Training Primary Care Champions program. Fellows must continue to provide clinical services at the primary care site through the course of the fellowship program. Understanding and commitment to these requirements should be delineated in a letter of agreement from each partnering primary care site.

2. Train fellows in the areas of leadership, health care transformation, and education. Training should include content to address competencies in the areas of leadership,18 team-based integrated health care, quality improvement, population health, social determinants of health, health policy, and education.19

3. Support fellows in the selection and implementation of a health care transformation project in their community-based primary care site. These projects should be matched with the needs of the primary care site, have clearly defined goals, objectives, and expected outcomes, and have clear evaluation plans to determine the impact of these projects on improving health in the primary care site. Fellows must receive appropriate mentorship and support for these projects and evaluation outcomes should be matched to relevant quality outcomes, for example Uniform Data Systems (UDS) quality outcomes for Health Centers and CMS Clinical Quality Measures for EHR Incentive Programs quality measures.

The fellowship training must be at least one year and not longer than two years.

HRSA will convene grant recipients and fellows annually for an in-person meeting.

Applicants are encouraged to address the HHS clinical priorities of opioid abuse, mental health, and childhood obesity through their training and fellows’ health care transformation projects.

Logic Model You must submit a logic model for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

18 Examples of relevant leadership competencies can be found at:

• http://www.ahaphysicianforum.org/files/pdf/LeadershipEducation.pdf

• http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_

Leadership.pdf 19 Examples of relevant education competencies can be found at:

• https://www.stfm.org/fmhub/fm2007/May/Dona343.pdf http://bphc.hrsa.gov/qualityimprovement/performancemeasures/index.html http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Eligible-Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Eligible-Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf http://www.ahaphysicianforum.org/files/pdf/LeadershipEducation.pdf http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_Leadership.pdf http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint292_Leadership.pdf https://www.stfm.org/fmhub/fm2007/May/Dona343.pdf

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• Goals of the project (e.g., objectives, reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

• Inputs (e.g., organizational profile, collaborative partners, key staff, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

The logic model should be provided in Attachment 9.

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

You must provide a detailed work plan narrative and chart that demonstrates your experience implementing a project of the proposed scope (a sample work plan can be found here:

https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf.

You must:

Provide a detailed description of the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance.

Describe the timeframes, deliverables, and key partners required during the grant period of performance, including a training chart with the expected number of fellows to be recruited, trained, and graduated for each year of the grant period.

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

Identify meaningful support and collaboration with key stakeholders, particularly required partners for this NOFO, in planning, designing and implementing all activities, including development of the application and how the community-based primary care sites will be involved in the selection and ongoing support of individual primary care fellowship candidate(s).

• Describe any plans to leverage the NHSC LRP, as described in section 1, to support your proposed project and fellows.

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

• Describe dissemination activities for each year of the project.

• Describe evaluation activities for each year of the project.

• Attach the work plan, tables, and charts as appropriate in Attachment 4.

The minimum number of fellows per training period is four physicians and/or physician assistants for one-year programs and eight for two-year programs. To meet the minimum number of fellows required, fellows must meet all of the following criteria:

https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf

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A. Have a medicine or physician assistant degree (MD/DO or PA);

B. Be board certified or board eligible in family medicine, general internal medicine, or general pediatrics; or be certified as a physician assistant;

C. Have a position in a community-based primary care site; and D. Have a record of practice in a primary care discipline field for at least two years.

Beyond the minimum number of required physician and/or physician assistant fellows, you may choose to train additional primary care fellows in other health professions and/or recruit interprofessional fellowship teams.

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

#2 (c)

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

IMPACT -- This section includes 2 sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a)

You must describe the plan for program performance evaluation. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, budget, and other resources); key processes; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported. You must specifically include a plan for evaluating any improvements in patient access, quality of care, and cost effectiveness as a result of training and health care transformation projects.

Programs will be required to report on their evaluation progress and findings in their annual Progress Report. In addition, a summary brief of each fellow’s health care transformation project will be required to be submitted with the annual Progress Report.

You also must describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. At the following link, you will find the required data forms for this program:

https://bhw.hrsa.gov/grants/reportonyourgrant. Describe the data collection strategy to collect, manage, analyze and track data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how https://bhw.hrsa.gov/grants/reportonyourgrant

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the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes.

For implementation of the program performance evaluation and HRSA’s performance measures requirements, describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature. Describe any potential obstacles and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3

(b)

You must provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding, as well as (c) provide a timetable for becoming self-sufficient. Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. You must discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES –

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations. Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings. Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

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A project organizational chart is requested in Section IV.2.v, Attachment 3.