oppHRSA-19-006-cfda93.255-cidHRSA-19-006-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Children’s Hospitals Graduate Medical Education (CHGME) Payment

Program Funding Opportunity Number: HRSA-19-006

Funding Opportunity Type: Competing Continuation, New

Catalog of Federal Domestic Assistance (CFDA) No. 93.255

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Phase 1: Application Due Date in Grants.gov:

August 17, 2018

Phase 2: Supplemental Information Due Date in EHBs:

August 31, 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 1 month to complete.

Issuance Date: June 29, 2018

Marshala Lee, Branch Chief Graduate Medical Education Branch, Division of Medicine and Dentistry Telephone: (301) 443-6191 Fax: (301) 443-1879 E-mail: MLee1@hrsa.gov

Authority: Section 340E of the Public Health Service Act as most recently amended by the Children’s Hospital GME Support Reauthorization Act of 2013.

https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf.

HRSA-19-006 ii

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019 Children’s Hospitals Graduate Medical Education (CHGME) Payment Program. The purpose of this program is to fund freestanding children’s hospitals to support the training of pediatric and other residents in graduate medical education (GME) programs.

Funding Opportunity Title: Children’s Hospitals Graduate Medical Education Payment Program

Funding Opportunity Number: HRSA-19-006

Due Date for Applications: Grants.gov (Phase 1): August 17, 2018 HRSA EHBs (Phase 2): August 31, 2018

Anticipated Total Annual Available FY19 Funding:

$298,000,000

Estimated Number and Type of Awards: 55-65 awards

Estimated Award Amount: Formula awards, varies

Cost Sharing/Match Required: No

Period of Performance: October 1, 2018 through September 30, 2019 (one year)

Eligible Applicants: Freestanding children’s hospitals whose inpatients are predominantly under 18 years of age, who participate in an approved GME program, and have a Medicare payment agreement.

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

HRSA-19-006 iii

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Two-Tier Application Guide, available online at https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf, except where instructed in this NOFO to do otherwise.

Submissions

The CHGME Payment Program requires two submissions during the Federal FY: (1) an initial application to determine interim payments, and (2) a reconciliation application to finalize the number of full-time equivalent resident counts and subsequently determine final payments. CHGME Payment Program awardees applying for the Quality Bonus System payment must submit required documents in the reconciliation application.

Technical Assistance

HRSA has scheduled the following technical assistance webinar to help you understand, prepare, and submit an application for this Notice of Funding Opportunity:

Webinar

Day and Date: Thursday, July 26, 2018 Time: 2:00 – 3:30 p.m. ET Call-In Number: 877-397-0291 Participant Code: 798335 Weblink: https://hrsaseminar.adobeconnect.com/hrsa_19_006_chgme/ https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://hrsaseminar.adobeconnect.com/hrsa_19_006_chgme/

HRSA-19-006 iv

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. 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. QUALITY BONUS SYSTEM PAYMENT

4. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX A

I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Children’s Hospitals Graduate Medical Education (CHGME) Payment Program. Federal funding for graduate medical education (GME) is primarily provided by the Centers for Medicare & Medicaid Services (CMS) and goes to full service teaching hospitals that serve primarily adult patients. Freestanding children’s hospitals receive little to no GME funding from Medicare because children’s hospitals have a low Medicare caseload. The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal GME funding for freestanding children’s teaching hospitals versus other types of teaching hospitals. The CHGME Payment Program is administered by the Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS).

2. Background

This program is authorized by Section 340E of the Public Health Service Act, as most recently amended by the Children’s Hospital GME Support Reauthorization Act of 2013.

In 1999, Congress addressed the difference of explicit GME funding between freestanding children’s teaching hospitals and other teaching hospitals by passing the Healthcare Research and Quality Act, which established the CHGME Payment Program. There have been several amendments, and in April 2014, Congress reauthorized the CHGME Payment Program for a period of five years, expanding eligibility to include certain hospitals (see Section III. Eligibility Information).

The CHGME Payment Program supports HRSA’s mission to improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs. HRSA improves the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. HRSA oversees several grant programs that support the placement of providers, provide financial support to students in health professions programs, provide continuing education to current health professionals, and foster the development of curricula that promote quality health care.

The nearly 60 freestanding children’s teaching hospitals across the country train about 48 percent of all pediatric residents and 53 percent of pediatric specialists training in the U.S. annually, and provide valuable training for physicians in many other specialties.1 These are the physicians who care for America’s youngest population – its children.

Representing about 1 percent of all short-term acute care hospitals, these hospitals provide almost 50 percent of the patient care to low-income children, including those

1 Children’s Hospital Graduate Medical Education Program highlights available at:

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/childrens-hospital-highlights.pdf.

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/childrens-hospital-highlights.pdf covered by Medicaid and those who are uninsured.2,3 In addition, these hospitals are regional and national referral centers for critically ill children, often serving as the only source of care for many critical pediatric services. Freestanding children’s hospitals provide care to a large percentage of children with medical complexity (CMC) and more than one-third of hospitalizations at freestanding children’s hospitals were for CMC compared to one-in-five at general hospitals.4 This program provides the funding needed to support children’s hospitals in providing residency training.5

The CHGME Payment Program is designed to support the three-pronged missions of freestanding children’s teaching hospitals that comply with the social mission of medical education:6

Educate and train future pediatricians, pediatric sub-specialists, and other non-pediatric residents, Provide care for vulnerable and underserved children, and

Conduct innovative and valuable pediatric research.

Funding children’s hospitals is at the core of HRSA’s mission of strengthening the health workforce and connecting skilled professionals to communities in need.

The CHGME Program Payment statute allows the Secretary of HHS to establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program that meet standards specified by the Secretary. The goal of the Quality Bonus System (QBS) is to recognize and incentivize CHGME Payment Program awardees with high quality training to meet the pediatric workforce needs of the nation. In FY 2017, HRSA began engaging stakeholders in efforts to develop the CHGME QBS. In FY 2018, HRSA released a Federal Register Notice to seek public comment on the proposed CHGME QBS (available online at https://www.gpo.gov/fdsys/pkg/FR-2017-10-16/pdf/2017-22381.pdf). Nearly all commenters supported establishing the CHGME QBS to recognize and reward quality training programs for residents supported by the CHGME program and agreed with the approach to recognize engagement in initiatives geared towards transforming pediatric health care to improve access, quality, and cost effectiveness. However, many commenters indicated the proposed approach could be enhanced by starting with documentation of transformation activities in which residents are involved. Based on the comments received in the Federal Register Notice, HRSA plans to implement the

2 Fast facts on US hospitals [Internet]. Chicago (IL): AHA; 2018 [cited 2018 Feb 7]. Available from:

https://www.aha.org/statistics/2018-01-09-fast-facts-us-hospitals-2018-pdf 3 Colvin, Jeffrey D., et al. "Financial Loss for Inpatient Care of Medicaid-Insured Children." JAMA pediatrics

170.11 (2016): 1055-1062.

4 Leyenaar, JoAnna K. et al. “Epidemiology of Pediatric Hospitalizations at General Hospitals and Freestanding

Children’s Hospitals in the United States.” Journal of hospital medicine 11.11 (2016): 743–749. PMC. Web. 7 Feb.

2018.

5 Supporting Children’s Hospitals and Children Health: The Role of the Federal “CHGME” Program. Prepared by

The Lewin Group for the National Association of Children’s Hospitals, September 5, 2006 6 Financing Graduate Medical Education to meet the need of Children and the future of the Pediatrician Workforce.

Pediatrics, Volume 121, Number 4, April 2008.

https://www.gpo.gov/fdsys/pkg/FR-2017-10-16/pdf/2017-22381.pdf https://www.aha.org/statistics/2018-01-09-fast-facts-us-hospitals-2018-pdf first phase of the CHGME QBS in FY 2019 as further outlined in this NOFO (Section V.3 Quality_Bonus_System).

II. Award Information

1. Type of Application and Award

Type of applications sought: Competing Continuation and New.

HRSA will provide funding in the form of a formula-based payment program. The funds available for the CHGME Payment Program are distributed among participating eligible children’s hospitals. Hospitals that meet eligibility requirements in Section III.1 receive funds based on the annual appropriation.

Traditionally, the CHGME Program makes monthly payments to distribute the Direct Medical Education (DME) and Indirect Medical Education (IME) funding. Each of the funding amounts is determined by formula, and a hospital receives its proportion of the total CHGME Payment Program funding based on the calculation of the formula. For DME, the CHGME Payment Program funding is proportional to the number of residents the hospital trains. Furthermore, the DME payment formula accounts for a hospital’s specific geographic variations in costs, and inflation. For IME, the CHGME funding takes into account the severity of illness of its inpatients, the number of available beds, as well as the number of residents the hospital trains.

2. Summary of Funding

HRSA expects approximately $298,000,000 to be available to fund 55-65 awardees.

The actual amount of CHGME Payment Program funding available, if any, will not be determined until enactment of the final FY 2019 federal appropriation. The FY 2019 President’s Budget proposes to provide GME support for children’s hospital as part of a broader GME reform effort supported with mandatory funds. Legislative action is needed for this proposal to be enacted. This notice is a contingency action taken to ensure that applications can be processed and funds awarded in a timely manner should funds become available for the existing program under current law. The period of performance is October 1, 2018 through September 30, 2019 (one year).

In April 2014, the CHGME Payment Program was reauthorized to expand eligibility to “Newly Qualified Hospitals” that meet the eligibility requirements in Section III.1.b. The reauthorization permits the Secretary, “to make available up to 25 percent of the total amounts in excess of $245,000,000 …but not to exceed $7,000,000” for the purpose of making CHGME Program payments to these Newly Qualified Hospitals.

In FY 2018, Congress appropriated $315 million to the CHGME Payment Program. Of this, approximately $4 million in payments were made to newly qualified hospitals. If funding levels and mechanisms remain constant, it is estimated that approximately $3 million may be available in FY 2019 for the CHGME QBS. If the total amount available for the CHGME QBS in FY 2019 is less than $2 million, HRSA does not plan to implement the CHGME QBS in FY 2019 to minimize administrative burden on the hospitals. In this case, the funds would be disbursed to all eligible hospitals (including those newly qualified) according to the CHGME Program formula payment methodology.

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

III. Eligibility Information

1. Eligible Applicants

There are two categories of children’s hospitals that may be eligible for CHGME payments in FY 2019, depending on the funding appropriated to the program – “Currently Eligible Hospitals” or “Newly Qualified Hospitals.” Hospitals that are applying for the first time for the CHGME program may be hospitals that are eligible as a “Newly Qualified Hospital” or hospitals that are new to the CHGME program but qualify under the “Currently Eligible Hospitals” requirements.

a. Currently Eligible Hospitals: Includes freestanding children’s hospitals that meet the original eligibility requirements for CHGME payments that were established prior to the Children’s Hospital GME Support Reauthorization Act of 2013. These freestanding children’s hospitals must meet the following criteria:

1) Participate in an approved GME residency training program as defined in section

1886(h)(5)(A) of the SSA;

2) Have a Medicare payment agreement;

3) Are excluded from the Medicare Inpatient Prospective Payment System (IPPS) under section 1886(d)(1)(B) of the Social Security Act (SSA) and its accompanying regulations; and

4) Its inpatients are predominantly individuals under 18 years of age.

b. Newly Qualified Hospitals: As per the Children’s Hospital GME Support Reauthorization Act of 2013, a freestanding hospital may be eligible for CHGME payments depending on the level of funding appropriated to the program if it meets the following criteria:

1) Participate in an approved GME residency training program as defined in section

1886(h)(5)(A) of the SSA;

2) Have a Medicare payment agreement;

3) Are excluded from the Medicare Inpatient Prospective Payment System (IPPS) under section 1886(d)(1)(B) of the Social Security Act (SSA) and its accompanying regulations;

4) Its inpatients are predominantly individuals under 18 years of age; and https://www.ecfr.gov/cgi-bin/text-idx?SID=ad608f0f0aaf8112d03deadbfb3b0a83&mc=true&tpl=/ecfrbrowse/Title45/45cfr75_main_02.tpl

5) Are not otherwise qualified to receive payments under this section or section 1886(h) of the SSA.

For those freestanding children’s hospitals that met the above requirements as of April 7, 2014, and the Secretary had not previously determined an average number of FTE residents under section 1886(h)(4) of the SSA, the Secretary may establish such number of FTE residents for the purposes of calculating CHGME program payments.

Any public or private nonprofit and for-profit children's teaching hospital with an accredited residency training program that meets all of the above requirements for either category of eligibility may apply, though final eligibility for receiving funds as a “newly qualified hospitals” will depend on appropriated funding levels. Children’s hospitals applying for the CHGME Payment Program must train residents during the federal fiscal year for which they apply for funds.

2. Cost Sharing/Matching

Cost sharing or matching is not required for this program.

3. Other

Payments will be determined in compliance with all mandates, rules, regulations, policies, and guidance guiding the program.

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.

Multiple Applications: Multiple applications from an organization are not allowable.

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 will result in an application being considered incomplete or non-responsive. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

Hospitals that are newly qualified to receive CHGME funds as “Newly Qualified Hospitals” under the Children’s Hospital GME Support Reauthorization Act of 2013, as of April 7, 2014, and that do not already have a CMS cap established and are not able to apply for a CMS cap as a new residency training program, will have a “CHGME cap” established. The “CHGME cap” will be established using the number of FTEs trained during the most recent Medicare cost report period completed on or before April 7, 2014. This value will be entered on sections 4, 5, and 6, of the HRSA 99-1, on lines 4.06, 5.06, and 6.06 as applicable. The “CHGME cap” reported by newly qualified hospitals will be verified by the CHGME auditors during the FY 2019 audit process.

Documentation Recommendations

Hospitals are responsible for the accuracy of application data submitted to HRSA and are subject to audit. Hospitals are not required to submit documentation with their initial application to support resident counts reported on their CHGME Payment Program application. However, hospitals should be prepared to produce documentation in accordance with 42 CFR 413.75(d) in any subsequent audit carried out by HHS or its delegate. The CHGME Payment Program has in place a Resident FTE Assessment (audit) process. Auditors conduct an assessment of the resident FTE counts each Federal fiscal year between October and March. The results of these FTE assessments are the basis for the hospitals’ reconciliation applications. The audit methodology complies with the requirements under 42 CFR 413.75(d) and parallels a similar GME audit process carried out by CMS to adjudicate the number of residents training in teaching hospitals with primarily adult patients. Children’s hospitals that do not report resident FTE counts to Medicare are not exempt from this policy. An official of the hospital must verify the information provided in the application used to support the number of FTE residents for a particular cost-reporting period.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov and the HRSA Electronic Handbooks (EHBs). You must use a two-tier submission process for the CHGME Payment Program following the directions provided at Grants.gov and the HRSA EHBs. HRSA encourages you to apply through Grants.gov using the SF-424 R&R Two-Tier workspace application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

• Phase 1 – Grants.gov – Required information must be submitted via Grants.gov with a due date of August 17, 2018, at 11:59 P.M. Eastern Time; and

• Phase 2 – HRSA EHBs – Supplemental information (completing data forms HRSA

99; 99-1; 99-2; and 99-5, as well as required Attachments) must be submitted via the EHBs with a due date of August 31, 2018, at 5:00 P.M. Eastern Time.

Only applicants who successfully have an application validated in Grants.Gov (Phase 1) by the August 17, 2018 due date may submit the additional information and CHGME Payment Program data forms in the HRSA EHBs (Phase 2).

http://www.grants.gov/applicants/apply-for-grants.html

If you’re reading this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) and reviewing or preparing the workspace application package, you will automatically be notified in the event HRSA changes and/or republishes the NOFO 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 For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Unless indicated otherwise in this NOFO, you must submit the information outlined in the Application Guide in addition to the program specific information below. You should not attach any supporting documentation that contains personal identifying information with the application including rotation schedules, IRIS data, etc. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Two- Tier Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and must be in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 9.5 of the SF-424 R&R Two-Tier Application Guide for the Application Completeness Checklist.

Applications must be complete and validated by Grants.gov under the correct funding opportunity number prior to the Phase 1 deadline, and supplemental information must be submitted in the EHBs prior to the Phase 2 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 as Attachment #5.

See Section 5.1 viii of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information on all certifications.

Program-Specific Instructions Neither a project abstract, a project narrative, nor budget information is required for this funding opportunity. In conjunction with the application requirements and instructions in https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/ https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf

Section 5 of HRSA’s SF-424 R&R Two-Tier Application Guide, please note the following:

Phase 1. Grants.gov application: Required information must be complete and successfully validated under the correct funding opportunity number by 11:59 p.m. Eastern Time on August 17, 2018.

The following should be included as part of the Grants.gov submission:

a) SF-424 R&R cover page

b) Project/Performance Site Location(s) form; and

c) Disclosure of Lobbying Activities (SF-LLL), if applicable.

Phase 2. HRSA EHBs: Registration and applications must be complete and successfully submitted by your organization’s Authorizing Official by 5:00 PM Eastern Time on August 31, 2018. Please note that you can only begin Phase 2 in the HRSA EHBs after Phase 1 in Grants.gov has been completed by the applicable due date and HRSA has assigned the application a tracking number.

Program-Specific Forms

The CHGME application includes four (4) forms that are available electronically in the EHBs:

a) HRSA 99: Demographic and Contact Information Form

b) HRSA 99-1: Determination of Weighted and Unweighted Resident FTE Count

Form

c) HRSA 99-2: Determination of Indirect Medical Education Data Related to the

Teaching of Residents Form

d) HRSA 99-5: Application Checklist

Copies of these forms are included in the NOFO for your reference (Attachment A). Do not include these tables as part of the Grants.gov application submission since you will be entering the data online in the HRSA EHBs by accessing the CHGME web application as part of Phase 2.

i. Attachments

Please provide the following items to complete the content of the application. Each attachment must be clearly labeled, and is to be submitted during Phase 2 of the application, directly in the EHBs:

Attachment 1 – If the hospital files a full Medicare Cost report with CMS, attach Worksheet E-3 part IV or Worksheet E-4 of the Medicare Cost Reports for each of the Medicare Cost Report periods (where applicable).

Attachment 2 – Medicare Affiliation agreements when the hospital utilizes such agreements to increase/decrease its 1996 FTE resident cap, including a letter indicating that the affiliation agreements were filed with CMS prior to July 1 of that affiliation agreement’s academic year.

Attachment 3 – Documents providing support of additions or reductions to resident FTE cap, if applicable.

Attachment 4 – Evidence of non-profit status, if applicable.

Attachment 5 – Delinquency on Federal debt explanation and/or Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification explanation, if applicable.

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

You must obtain a valid DUNS number, also known as the Unique Entity Identifier for your organization/agency and provide that number in their application. You must also register with the System for Award Management (SAM) and continue to maintain active SAM registration with current information at all times during which it has an active federal award or an application or plan under consideration by an agency (unless the applicant is an individual or federal agency that is exempted from those requirements under 2 CFR 25.110(b) or (c), or has an exception approved by the agency under 2 CFR 25.110(d)).

HRSA may not make an award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time HRSA is ready to make an award, HRSA may determine that the applicant is not qualified to receive an award and use that determination as the basis for making an award to another applicant.

If you have already completed Grants.gov registration for HRSA or another Federal agency, confirm that it is still active and that the Authorized Organization Representative (AOR) has been approved.

The Grants.gov registration process requires information in three separate systems:

Dun and Bradstreet (http://www.dnb.com/duns-number.html)

System for Award Management (SAM) (https://www.sam.gov)

Grants.gov (http://www.grants.gov/)

For further details, see Section 3.1 of HRSA’s SF-424 R&R Two-Tier Application Guide.

ALERT from SAM.gov: You must now provide an original, signed notarized letter stating that you are the authorized Entity Administrator before your registration will be activated by SAM.gov. Please read these FAQs to learn more about this process change. Plan for additional time associated with http://www.dnb.com/duns-number.html) https://www.sam.gov/ http://www.grants.gov/ https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.fsd.gov/fsd-gov/answer.do?sysparm_kbid=d2e67885db0d5f00b3257d321f96194b&sysparm_search=kb0013183 https://www.fsd.gov/fsd-gov/answer.do?sysparm_kbid=d2e67885db0d5f00b3257d321f96194b&sysparm_search=kb0013183 https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/sam-update submission and review of the notarized letter. This requirement is effective March 22, 2018 for new entities registering in SAM. This requirement is effective April 27, 2018 for existing registrations being updated or renewed. Entities already registered in SAM.gov are advised to log into SAM.gov and review their registration information, particularly their financial information.

SAM.gov is experiencing high volume and delays. If you have tried to create or update your SAM.gov registration but have not been able to complete the process, you may not be able to apply for a HRSA funding opportunity via Grants.gov in a timely manner prior to the application deadline. If so, please email DGPwaivers@hrsa.gov, per the instructions in Section 3.6 of your HRSA Application Guide.

If you fail to allow ample time to complete registration with SAM or Grants.gov, you will not be eligible for a deadline extension or waiver of the electronic submission requirement.

4. Submission Dates and Times

Application Due Date The due dates for applications under this NOFO are as follows:

Grants.gov (Phase 1): August 17, 2018 at 11:59 P.M. Eastern Time

HRSA EHBs (Phase 2): August 31, 2018 at 5:00 P.M. Eastern Time.

See Section 9.2.5 – Summary of e-mails from Grants.gov of HRSA’s SF-424 R&R Two- Tier Application Guide for additional information.

5. Intergovernmental Review

The CHGME Payment Program is not subject to the provisions of Executive Order 12372, as implemented by 45 CFR 100.

See Section 5.1 ii of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

6. Funding Restrictions

It is anticipated that funds awarded under this payment program will be for direct and indirect graduate medical expenses for a period of performance of one (1) year.

Funding is dependent on the availability of funds and will be determined based on Congressional appropriated dollars.

Funds under this notice may not be used for purposes specified in HRSA’s SF-424 R&R Two-Tier Application Guide.

https://sam.gov/portal/SAM/ mailto:DGPwaivers@hrsa.gov https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf

The General Provisions in Division H of the Consolidated Appropriations Act, 2018 (P.L.

115-141), apply to this program. Please see Section 5.1.iv of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information. Note that these or other restrictions may apply in FY 2019, as required by law.

You are required to have the necessary 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. Like those for all other applicable award requirements, the effectiveness of these policies, procedures and controls is subject to audit.

V. Application Review Information

1. Review Criteria

This is a formula-based payment program that does not require submission of a project narrative for review by a review committee. HRSA is responsible for the review of each application for eligibility, completeness and accuracy (including the data reported on all tables), and compliance with the requirements outlined in this NOFO. Application review is conducted at HRSA and fiscal intermediaries conduct an independent assessment of FTE resident count. Section 340E(e)(3) of the Public Health Service Act states “[t]he Secretary shall determine any changes to the number of residents reported by a hospital in the application of the hospital for the current fiscal year to determine the final amount payable to the hospital for the current fiscal year for both direct expense and indirect expense amounts.” The assessment of the FTE resident count by fiscal intermediaries occurs within a six-month period from the start of the Federal FY to the spring of the same Federal FY, to allow for reconciliation of payments within the appropriation year for which payments are made. CHGME fiscal intermediaries carry out the FTE assessment of residents each fiscal year, and each of the children’s hospitals participating in the program is subject to this assessment. The final amount determined through the reconciliation process is subject to administrative and judicial review under section 1878 of the Social Security Act.

2. Review and Selection Process

The funds appropriated for the CHGME Payment Program are distributed among participating institutions as a formula-based payment program. Program data reported on HRSA forms are used to determine funding and administer the program. All required tables must be submitted electronically in the HRSA EHBs with the Phase 2 submission. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

3. Quality Bonus System Payment

In order to qualify for the QBS payment, CHGME awardees must submit as an attachment in the FY 2019 reconciliation application released in April 2019, documentation describing the hospital’s initiatives, resident curriculum, and direct resident involvement in the following areas:

a. Integrated care models (e.g., integrated behavioral and mental health, care coordination across providers and settings)

b. Telehealth and/or Health Information Technology

c. Population health

d. Social determinants of health, and

e. Additional initiatives to improve access and quality of care to rural and/or underserved communities

In all areas, CHGME awardees must highlight initiatives aimed at improving access and quality of care to rural and/or underserved communities.

The attachment must include the headings listed above. If your hospital is not currently engaged in one or more of these areas, please describe the steps that your hospital will be taking in the future to participate in these areas.

HRSA recognizes quality improvement, patient safety, and provider/resident wellness initiatives as transformation areas recently added to the Accreditation Council for Graduate Medical Education Common Program Requirements.7 However, given all residency programs have until July 1, 2019 to address these requirements, CHGME QBS will not focus on these areas.

Additional submission instructions will be included in the reconciliation application.

Payment Structure: QBS payments will be disbursed with the CHGME FY 2019 reconciliation payments. CHGME hospitals that submit the required documentation outlined above with the FY 2019 reconciliation application will receive a portion of the available funds for the CHGME QBS payment. Amounts will be distributed according to a three-tiered payment structure that recognizes the different annual payment levels received by CHGME hospitals. Hospitals that submit the required QBS documentation detailed above will be evenly divided into three tiers, based on their combined direct and indirect fiscal year payment amounts, as calculated per the established CHGME program formulas. The base payment rate would be determined from the total amount available and the number of hospitals that qualify for the CHGME Quality Bonus System in a fiscal year.

Tier 1: Hospitals that qualify for the quality bonus payment that are in the lowest third of calculated CHGME annual payments among hospitals that qualify for the

7 Accreditation Council for Graduate Medical Education Common Program Requirements, available at:

http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf.

http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf quality bonus payment of calculated CHGME annual payments will receive a base payment.

Tier 2: Hospitals that qualify for the quality bonus payment that are in the middle quality bonus payment will receive two times the base payment.

Tier 3: Hospitals that qualify for the quality bonus payment that are in the highest quality bonus payment will receive three times the base payment.

4. Assessment of Risk and Other Pre-Award Activities

HRSA may elect not to fund applicants with management or financial instability that directly relates to the organization’s ability to implement statutory, regulatory or other requirements (45 CFR § 75.205).

HRSA reviews applications for other considerations that include past performance, as applicable, cost analysis of the project/program budget, assessment of your management systems, ensuring continued applicant eligibility, and compliance with any public policy requirements, including those requiring just-in-time submissions. HRSA may ask you to submit additional programmatic or administrative information or to undertake certain activities in anticipation of an award. However, even at this point in the process, such requests do not guarantee that HRSA will make an award. Following review of all applicable information, the HRSA’s approving and business management officials will determine whether HRSA can make an award, if special conditions are required, and what level of funding is appropriate.

Award decisions are discretionary and are not subject to appeal to any HRSA or HHS official or board.

Effective January 1, 2016, HRSA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS). You may review and comment on any information about your organization that a Federal awarding agency previously entered. HRSA will consider any of your comments, in addition to other information in FAPIIS in making a judgment about your organization’s integrity, business ethics, and record of performance under federal awards when completing the review of risk posed by applicants as described in 45 CFR § 200.205 Federal Awarding Agency Review of Risk Posed by Applicants.

HRSA will report to FAPIIS a determination that an applicant is not qualified ((45 CFR § 75.212).

https://www.fapiis.gov/fapiis/index.action https://www.fapiis.gov/fapiis/index.action https://www.fapiis.gov/ http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

VI. Award Administration Information

1. Award Notices

HRSA anticipates issuing/announcing Notice of Awards, subject to availability of funds, in October 2018. For “Newly Qualified Hospitals,” current law permits the Secretary of HHS “to make available up to 25 percent of the total amounts in excess of $245,000,000” but “not to exceed $7,000,000.” “Newly Qualified Hospitals” will not receive their payment, if any, until after the annual appropriation has been made, which may be after October, and only if the annual appropriation is funded at $245,000,000 or more for FY 2019. See Section 6.4 of HRSA’s SF-424 R&R Two-Tier Application Guide for additional information.

2. Administrative and National Policy Requirements

See Section 2.2 of HRSA’s SF-424 R&R Two-Tier Application Guide.

Requirements under Subawards and Contracts under Awards

The terms and conditions in the Notice of Award (NOA) apply directly to the recipient of HRSA funds. The recipient is accountable for the performance of the project, program, or activity; the appropriate expenditure of funds under the award by all parties; and all other obligations of the recipient, as cited in the NOA. In general, the requirements that apply to the recipient, including public policy requirements, also apply to subrecipients and contractors under grants, unless the NOA specifies an exception. See 45 CFR § 75.101 Applicability for more details.

3. Reporting

Award recipients must comply with Section 7 of HRSA’s SF-424 R&R Two-Tier Application Guide and the following reporting and review activities:

a. Audit Requirements HHS, or any other authorized Federal agency, may conduct an audit to determine whether the applicant has complied with all governing laws and regulations in its application for funding. All information submitted to HRSA by an applicant or participating hospital during or after the award of funds is subject to review in an audit.

In addition, a Resident FTE Assessment will be conducted between October and May of each fiscal year. A CHGME Fiscal Intermediary (FI) is assigned to each children’s hospital currently receiving CHGME Payment Program funding. The CHGME FI conducts an assessment of resident FTE counts reported by the children’s hospital in its initial application (HRSA 99-1) for

CHGME Payment Program funding to determine any changes to those https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 resident FTE counts prior to the CHGME Payment Program reconciliation application cycle. The CHGME FI follows a detailed protocol based on CMS rules and regulations designed to ensure that each resident FTE claimed by the children’s hospital is documented in accordance with 42 CFR 413.75(d).

Resident counts are based on the number of residents training at the hospital complex and certain non-hospital/non-provider settings/sites throughout the hospital’s fiscal year. Residents are counted as FTEs based on the total time necessary to fill a full-time residency slot for the year. Eligible hospitals are subject to the terms of the Resident FTE Assessment as required by Section

340E(e)(3) of the Public Health Service Act.

b. Progress Reports For this program, Government Performance and Results Act performance data tables are submitted as part of the reconciliation application, using the HRSA 99-4 form.

c. Performance Reports The recipient must submit a Performance Report to HRSA via EHBs on an annual basis. All HRSA recipients are required to collect and report performance data so that HRSA can meet its obligations under the Government Performance and Results Modernization Act of 2010. For the CHGME Payment Program, the performance report will be completed based on prior academic year data. Required measures include, but are not limited to program characteristics, individual resident demographics, experiential training details, curriculum enhancement and development, and discharge data. An overview of the required performance measures as well as a detailed instruction manual for performance reporting are available at the following site: https://bhw.hrsa.gov/grants/reportonyourgrant.

VII. Agency Contacts

You may request additional information and/or technical assistance regarding business, administrative, or fiscal issues related to this NOFO by contacting:

Jamie King, Chief, Health Professions Branch Division of Grants Management Operations Office of Federal Assistance Management, HRSA Room 10SWH03 5600 Fishers Lane Rockville, MD 20857 Telephone: 301-443-5461 Fax: 301-443-6343 E-mail: JKing@hrsa.gov https://bhw.hrsa.gov/grants/reportonyourgrant mailto:JKing@hrsa.gov

You may request additional information regarding overall program issues and/or technical assistance related to this NOFO by contacting:

Marshala Lee, Chief, Graduate Medical Education Branch Division of Medicine and Dentistry Bureau of Health Workforce, HRSA Room 15N142 5600 Fishers Lane Rockville, MD 20857 Telephone: 301-443-6191 Fax: 301-443-1879 E-mail: MLee1@hrsa.gov

You may need assistance when working online to submit your Phase 1 application forms electronically. Always obtain a case number when calling for support. For assistance with submitting the application in Grants.gov, contact Grants.gov 24 hours a day, seven days a week, excluding Federal holidays:

Grants.gov Contact Center Telephone: 1-800-518-4726 (International Callers, please dial 606-545-5035) E-mail: support@grants.gov Self-Service Knowledge Base: https://grants-portal.psc.gov/Welcome.aspx?pt=Grants

Applicants may need assistance when submitting Phase 2 information, and successful applicants/awardees may need assistance when working online to submit information and reports electronically through the HRSA EHBs. For assistance with submitting information in the HRSA EHBs, contact the HRSA Contact Center, Monday-Friday, 8:00 a.m. to 8:00 p.m. ET:

HRSA Contact Center Telephone: (877) 464-4772

TTY: (877) 897-9910

Web: http://www.hrsa.gov/about/contact/ehbhelp.aspx

VIII. Other Information

Technical Assistance

HRSA has scheduled the following technical assistance webinar:

Day and Date: Thursday, July 26, 2018 Time: 2:00 – 3:30 p.m. ET Call-In Number: 877-397-0291 Participant Code: 798335 Weblink: https://hrsaseminar.adobeconnect.com/hrsa_19_006_chgme/ https://www.hrsa.gov/grants/apply/applicationguide/sf424rr2guidev2.pdf.

mailto:

https://grants-portal.psc.gov/Welcome.aspx?pt=Grants https://grants-portal.psc.gov/Welcome.aspx?pt=Grants http://www.grants.gov/ https://hrsaseminar.adobeconnect.com/hrsa_19_006_chgme/

IX. Tips for Writing a Strong Application

See Section 5.7 of HRSA’s SF-424 R&R Two-Tier Application Guide.

In addition, BHW has developed a number of recorded webcasts with information that may assist applicants in preparing a competitive application. You can access these webcasts at http://www.hrsa.gov/grants/apply/writestrong/.

http://www.hrsa.gov/grants/apply/writestrong/

APPENDIX A

CHILDREN’S HOSPITALS GRADUATE MEDICAL EDUCATION

PAYMENT PROGRAM APPLICATION FOR PAYMENTS

Grants.gov (Phase 1) Submission due date August 17, 2018

SF 424 R&R Short Form o SF-424 R&R cover page o Project/Performance Site Location(s) form; and o Disclosure of Lobbying Activities (SF-LLL), if applicable.

HRSA EHBs (Phase 2) Submission due date August 31, 2018. Refer to Section IV of this notice for detailed instructions.

Applications are made by submission of the following:

HRSA 99: Demographic and Contact Information Form

HRSA 99-1: Determination of Weighted and Unweighted Resident FTE Count Form

HRSA 99-2: Determination of Indirect Medical Education Data Related to the Teaching of Residents Form

HRSA 99-5: Application Checklist

The application is available on the web by accessing the EHBs. Attachment A provides copies of the forms for reference; however, as indicated earlier, all forms must be completed directly in the EHBs.

Bureau of Health Workforce

Dear Applicant:

The Children’s Hospitals Graduate Medical Education (CHGME) Payment Program application package, including all applicable forms, guidance and instructions, is available on-line within

Health Resources and Services Administration’s Electronic Handbook (EHB). It is very important to thoroughly read the detailed application guidance and instructions before completing the required application forms. The material contains information related to submission of both the initial and reconciliation applications. A sample of the application is available on-line at http://bhpr.hrsa.gov/childrenshospitalgme/apply/index.html.

Your completed application must be submitted through the EHB following the guidance provided in the “Application Cycle and Deadlines” section of the application package.

Applications must be received by the stated deadlines to be considered for CHGME Payment

Program funding.

If you have questions regarding the application, please call the Graduate Medical Education

Branch at 301-443-1058 or e-mail at childrenshospitalgme@hrsa.gov.

Sincerely yours, /s/

Luis Padilla

Associate Administrator

Enclosures

Department of Health and Human Services OMB No. 0915-0247

Health Resources and Services Administration Expiration Date: 02/29/2020 http://bhpr.hrsa.gov/childrenshospitalgme/apply/index.html mailto:childrenshospitalgme@hrsa.gov

Children’s Hospitals Graduate Medical Education (CHGME)

Payment Program Application Package

Table of Contents

Section I:

Overview of the CHGME Payment Program

Introduction 6

Administration 7

Section II:

Application Cycle and Deadlines

Initial Application 8

Interim Payment Determination and Disbursement (Based Upon the Initial

Application)

Assessment of Resident Full-Time Equivalent Counts Reported in Initial

Applications

Reconciliation Application 10

Final Payment Determination and Disbursement (Based Upon the Reconciliation

Application)

Quality Bonus Payment System 12

Section III:

CHGME Payment Program Application Forms

Cover Page with Public Burden Statement 13

HRSA 99: Demographic and Contact Information 14

HRSA 99-1: Determination of Weighted and Unweighted Resident Full-Time

Equivalent Counts

HRSA 99-2: Determination of…