PKG00246145-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Geriatrics Workforce Enhancement Program

Funding Opportunity Number: HRSA-19-008

Funding Opportunity Type: New and Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number 93.969

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: February 6, 2019

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

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: November 8, 2018

Nina Tumosa, PhD Public Health Analyst Division of Medicine and Dentistry E-mail: ntumosa@hrsa.gov Telephone: (301) 443-5626 Fax: (301) 443-0162

Authority: Public Health Service (PHS) Act Title VII, Sections 750 and 753(a), and PHS Act Title VIII, Section 865.

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2019 Geriatrics Workforce Enhancement Program (GWEP). The purpose of this cooperative agreement program is to establish and operate geriatrics education centers that will implement the GWEP project to develop a healthcare workforce that maximizes patient and family engagement and improves health outcomes for older adults by integrating geriatrics and primary care. Special emphasis is on providing the primary care workforce with the knowledge and skills to care for older adults and partnering with community-based organizations (CBOs) to address gaps in healthcare for older adults, promote age-friendly health systems and dementia-friendly communities, and address the social determinants of health.

Funding may be used to support the education and training of health professions students, residents, fellows, and faculty; healthcare providers; and direct care workers who will provide healthcare to older adults. Funding may also be used to provide educational programs for individuals, patients, families, and caregivers to provide them with the knowledge and skills for self-management and/or care delivery for older adults.

Funding Opportunity Title: Geriatrics Workforce Enhancement Program Funding Opportunity Number: HRSA-19-008 Due Date for Applications: February 6, 2019 Anticipated Total Annual Available FY19 Funding:

$35,730,000

Estimated Number and Type of Awards:

Up to 47 cooperative agreements

Estimated Award Amount: Up to $750,000 per year which includes at least $100,000 for Alzheimer’s disease and related dementias (ADRD) education and training, subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: July 1, 2019 through June 30, 2024

(5 years)

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Eligible Applicants: Eligible applicants are accredited health professions schools and programs. The following entities are eligible applicants:

• Schools of Allopathic Medicine

• Schools of Veterinary Medicine

• Schools of Dentistry

• Schools of Public Health

• Schools of Osteopathic Medicine

• Schools of Chiropractic

• Schools of Pharmacy

• Physician Assistant Programs

• Schools of Optometry

• Schools of Allied Health

• Schools of Podiatric Medicine

• Schools of Nursing

The following accredited graduate programs are also eligible applicants:

• Health Administration

• Behavioral Health and Mental Health

Practice including:

• Clinical Psychology

• Clinical Social Work

• Professional Counseling

• Marriage and Family Therapy

Additional eligible applicants are:

• a health care facility,

• a program leading to certification as a certified nurse assistant,

• a partnership of a school of nursing and a health care facility, or

• a partnership of a program leading to certification as a certified nurse assistant and a health care facility.

See Section III-1 of this notice of funding opportunity (NOFO).

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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.

Technical Assistance

HRSA will hold a technical assistance (TA) webinar for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/ to learn more about the resources available for this funding opportunity.

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

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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 announces the opportunity to apply for funding under the Geriatrics Workforce Enhancement Program (GWEP).

Program Purpose The purpose of this program is to improve health outcomes for older adults by developing a healthcare workforce that maximizes patient and family engagement, and by integrating geriatrics and primary care.

Program Goals The goals of this program are: 1) to educate and train the primary care and geriatrics workforce to care for older adults in integrated geriatrics and primary care models, and

2) to partner with community based organizations (CBOs) to address gaps in healthcare for older adults, promote age-friendly health systems and dementia-friendly communities, and address the social determinants of health.

Program Objectives

1. Develop partnerships between academia, primary care delivery sites or systems, and community-based organizations to educate and train a workforce, including curriculum development as necessary, to provide value-based care that improves health outcomes for older adults.

2. Train geriatrics specialists, primary care providers, and health professions students, residents, fellows and faculty to assess and address the primary care needs of older adults, including:

• The continuum of care for older adults, including chronic care self-management, long-term care, and end-of-life care;

• Mental health issues, including delirium, depression, and substance and opioid use disorder;

• Social determinants of health, including elder abuse, neglect, and exploitation; disaster preparedness; and culturally and linguistically competent healthcare;

• Individual, community and population level approaches; and

• Use of telehealth technology, for example: teleprecepting, telementoring, Project ECHO1, live video, remote patient monitoring, or other technology as appropriate.

3. Transform clinical training environments into integrated geriatrics and primary care systems to become age-friendly health systems that incorporate the

1 Project ECHO is a lifelong learning and guided practice model that increases health workforce capacity to provide best-practice specialty care and reduce health disparities. The model includes a hub-and-spoke knowledge-sharing networks, led by expert teams who use multi-point videoconferencing to conduct virtual clinics with community providers. In this way, primary care doctors, nurses, and other clinicians learn to provide excellent specialty care to patients in their own communities. For more information see: https://echo.unm.edu/.

https://echo.unm.edu/

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principles of value-based care and alternative-payment models (e.g., Advanced Alternative Payment Modes [AAPMs], bundled payment, Comprehensive Primary Care Plus [CPC+]). The essential elements of age-friendly health systems are:

• What matters to the older adult

• Medication

• Mentation

• Mobility2

4. Deliver community-based programs that provide patients, families, caregivers, and direct care workers with the knowledge and skills to improve health outcomes for older adults;

5. Provide training to patients, families, caregivers, direct care workers, healthcare providers, and health professions students, residents, fellows and faculty on Alzheimer’s Disease and Related Dementias (ADRD) and how cognitive and behavioral impairments impact medical care throughout the course of illness, including the value of supporting dementia-friendly communities and when it is appropriate to recruit older adults into research.

Interprofessional collaboration is a required component of all project objectives, and medicine must be one of the professions included in all interprofessional activities.

Additional Program Information

Funding Preference This program provides the opportunity for the applicant to select one of two preferences.

One preference is authorized by Section 805 of the Public Health Service Act (PHS), and the other preference is authorized by Section 791(a)(1) of the PHS Act.

The funding preference under Section 805 of the PHS Act shall be given to applicants with projects that substantially benefit rural or underserved populations, or help meet public health nursing needs in State or local health departments.

The funding preference under Section 791 of the PHS Act shall be given to 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 b) demonstrate a significant increase in the rate of placing graduates in Medically Underserved Communities settings over the preceding two years. New programs as defined by PHS Act section 791(c) may apply for the preference through a different set of criteria found in Section V.2.

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

2 The John A. Hartford Foundation & The Institute for Healthcare Improvement. (2018). Age- Friendly Health Systems. Retrieved from https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly-hospitals/ https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly-hospitals/ https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly-hospitals/

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NOFO for detailed information on qualifying for a funding preference. Requested information to apply for the funding preference must be submitted in Attachment 8.

2. Background

The GWEP is authorized by PHS Act Title VII, Sections 750 and 753(a) and PHS Act Title VIII, Section 865. The focus of these authorities is on geriatrics workforce enhancement.

The current number of individuals over the age of 65 is 46 million and is projected to reach 74 million by 2030. Americans who are 65 today can expect, on average, to live an additional 19 years.3 As older adults live longer, many develop multiple chronic conditions (MCC). Approximately 75 percent will have at least one chronic condition, such as ADRD, which affects 1 in 10 older adults and is the 6th leading cause of death in the United States.4 MCC among older adults put a burden on national healthcare systems and increase costs.5 In 2017, HRSA’s National Center for Health Workforce Analysis published the National and Regional Projections of Supply and Demand for Geriatricians: 2013-20255 which reported that the demand for geriatricians is projected to exceed supply, resulting in a national shortage of 26,980 full time equivalent positions in 2025. This is despite warnings from 10 years ago, in The National Academy of Medicine, formerly called The Institute of Medicine, report titled, Retooling for an Aging America: Building the Health Care Workforce, that the healthcare workforce was even then inadequate in both size and skills to meet the healthcare needs of the rapidly growing number of older adults. The education and training of health professionals in the area of geriatrics has continued to be hindered by a shortage of faculty, inadequate and variable academic curricula and clinical experiences, and a lack of opportunities for advanced training.6

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be found in the Health Workforce Glossary. In addition, the following definitions apply to the Geriatrics Workforce Enhancement Program for Fiscal Year 2019.

Age-Friendly Health System means a healthcare system that improves the quality of care for older adults and optimizes value for health systems by providing older adults with the best care possible; reducing healthcare related harms to older adults to close to zero; satisfying older adults with their care; and optimizing value for individuals including

3National Prevention Council. Healthy Aging in Action. (2016). U.S. Department of Health and Human Services, Office of the Surgeon General, Washington, DC 4 2018 Alzheimer’s Disease Facts and Figures. https://www.alz.org/facts/ 5 Sage Open Nursing. (2018). Self-Management of Multiple Chronic Conditions by Community-Dwelling Older Adults: A Concept Analysis. Retrieved from https://doi.org/10.1177/2377960817752471 5 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2017. National and Regional Projections of Supply and Demand for Geriatricians: 2013-2025. Rockville, Maryland.

6Institute of Medicine. (2008). Retooling for an Aging America: Building the Health Care Workforce.

Washington, DC: The National Academies Press. https://doi.org/10.17226/12089.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.alz.org/facts/ https://doi.org/10.1177/2377960817752471 https://doi.org/10.17226/12089

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patients, families, caregivers, direct care workers, healthcare providers, and health professions students, residents, fellows, and faculty, and health systems. The essential elements of age-friendly health systems are a) What Matters (to the older adult); b) Medication; c) Mentation; and d) Mobility.

Caregiver means a family member, friend, neighbor or other individual who provides unpaid assistance to a person with a chronic illness or disabling condition.

Certification means a process by which an agency or organization validates, based upon predetermined standards, an individual health provider’s qualifications and knowledge for practice in a defined functional or clinical area.

Certified Nursing Assistant (CNA) Program means a CNA program provided by a community college, trade school, or medical facility that provides a 6-to-12 week CNA certificate program that is approved by the state’s nursing board.

Community-based organization means a public or private nonprofit that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety community needs.

Dementia Friendly Community means a community that helps people living with dementia feel included and supported in the places they work, live, and play (www.dfamerica.org). Dementia friendly communities consist of people who recognize that:

• A person living with dementia is more than his/her diagnosis;

• Dementia can affect a person’s cognition, behavior, emotions and physical capabilities; and,

• Everyone has a role to play in recognizing persons living with dementia as a part of their community and supporting their independence, value and inclusion.

Direct Care Worker means an individual employed to provide hands-on support to help people with disabilities, and older adults, to perform everyday activities.

Fellowship program means at least a one-year, interprofessional, organized training effort sponsored by an eligible applicant that is designed to provide training in integrating clinical geriatrics into primary care and geriatrics/primary care education for healthcare professionals who have completed a graduate education program in their discipline, and now seek to develop specialized knowledge and skill in the care of older adults. The fellowship program goal is to prepare the learner for interprofessional practice, and certification, in one or more specialties related to the care of older adults.

Fellows may be awarded stipends at a rate to be determined by the applicant organization. The goal of this program is to prepare individuals to be geriatrics specialists.

Graduate Education Program or Training means a program administered by an institution of higher learning, leading to a master’s or higher degree.

Health Care Facility (HCF) means an Indian Health Service health center, a Native Hawaiian health center, a federally qualified health center, a rural health clinic, a nursing http://www.dfamerica.org/

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home, a home health agency, a hospice program, a public health clinic, a state or local department of health, a skilled nursing facility, or any other facility designated by the Secretary.

Health Professional means an individual who has received an associate’s degree, a bachelor’s degree, a master’s degree, a doctoral degree, or post-baccalaureate training in a field relating to healthcare, and who shares in the responsibility for the delivery of healthcare services or related service.

Integrated primary care and geriatrics systems include, but are not limited to:

Interprofessional, team-based, patient-centered healthcare for older adults; integration of geriatrics into evolving age-friendly primary care delivery sites or systems to provide coordinated and comprehensive healthcare; and outreach and education for patients, families, caregivers, direct care workers, healthcare providers, and health professions students, residents, fellows and faculty to improve the health of older adults.

Interprofessional team means a group of three or more healthcare providers, direct care workers, caregivers, and patients who work together to meet the needs of a patient population. Work is divided based on the scope of practice of the included professions, information is shared, the work of each team member is supported, and processes and interventions are coordinated to provide services and programs to meet the patient’s goals. For the purposes of this program, medicine must be one of the professions included in the interprofessional team. (See also “Team Based Care”, in the Health Workforce Glossary).

Primary Care means a health care delivery site/system with integrated, accessible health care services provided 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.

For this program, primary care delivery site/system includes emergency departments, hospice, and skilled nursing facilities but does not include inpatient hospital settings (including ACE Units), ambulatory surgical centers; independent diagnostic testing facilities; and inpatient rehabilitation facilities.

Stipend means a payment to an individual to help meet that individual's subsistence expenses during the training period. Stipends are not salary, and should not be provided as a condition of employment with either the federal Government or the recipient/subrecipient organization.

Telehealth means the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.

Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications

Traineeships for the GWEP means traineeships that are limited to individuals who are preparing for advanced education nursing degrees in geriatrics nursing, long-term care, HRSA-19-008 6 gero-psychiatric nursing or other nursing areas that specialize in the care of the elderly population.

Value-based care refers to a form of reimbursement that ties payments for care delivery to quality of care provided. It supports better care for individuals, better health for populations, and lower costs.6

II. Award Information

1. Type of Application and Award

Type of applications sought: New and Competing Continuation.

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement, as opposed to a grant, is a financial assistance mechanism where substantial involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

In addition to the usual monitoring and technical assistance provided under the cooperative agreement, HRSA program involvement will include:

• Participating in the planning, development, and evaluation of all phases of the project;

• Reviewing procedures to be implemented for accomplishing the objectives of the cooperative agreement;

• Participating, as appropriate, in meetings or site visits conducted during the period of the cooperative agreement;

• Reviewing project training and education products such as videos, toolkits, assessment tools, on-line curricula, and manuscripts as they are being developed and prior to dissemination;

• Assisting recipients and their partners in developing a national GWEP network to share resources, best practices, and lessons learned;

• Providing assistance and referrals in the establishment and facilitation of effective reciprocal partnerships with federal, state and local agencies, HRSA projects and other resource centers, and other entities that may be relevant to the project’s mission;

• Providing programmatic input and consultation for development and delivery of education and training materials;

• Working with recipients and their partners to develop and implement quality improvement assessment and evaluation strategies in order to provide value-based care delivery and quality improvement initiatives;

• Providing information resources; and

• Review contracts and agreements, as appropriate, between programs and their partners.

6 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based- Programs/Value-Based-Programs.html

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The cooperative agreement recipient’s responsibilities shall include:

• Participating in ongoing monthly technical assistance calls with other recipients and HRSA staff;

• Providing the HRSA project officer with an opportunity to review project information prior to dissemination;

• Establishing contacts relevant to the project’s mission such as GWEP partners, federal, state, and local partners, and other HRSA projects;

• Coordinating activities with other GWEP awardees where possible; and

• Working with HRSA to evaluate priorities and respond to HRSA reporting requirements.

2. Summary of Funding

HRSA expects approximately $35,730,000 to be available annually to fund approximately 47 recipients. You may apply for a ceiling amount of up to $750,000 per year, of which no more than $650,000 of the funds will be used for non-ADRD education and training, and a minimum of $100,000 will be used for ADRD education and training.

The period of performance is five (5) years, from July 1, 2019 through June 30, 2024.

Funding beyond the first year is subject to the availability of appropriated funds for the GWEP, satisfactory awardee 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 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 exclusive of equipment, tuition and fees, and sub-awards/subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are accredited health professions schools and programs. The following entities are eligible applicants:

• Schools of Allopathic Medicine

• Schools of Veterinary Medicine

• Schools of Dentistry

• Schools of Public Health

• Schools of Osteopathic Medicine

• Schools of Chiropractic

• Schools of Pharmacy

• Physician Assistant Programs 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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• Schools of Optometry

• Schools of Allied Health

• Schools of Podiatric Medicine

• Schools of Nursing

The following accredited graduate programs are also eligible applicants:

• Health Administration

• Behavioral Health and Mental Health Practice including:

o Clinical Psychology o Clinical Social Work o Professional Counseling o Marriage and Family Therapy

Additional eligible applicants are:

• a health care facility

• a program leading to certification as a certified nurse assistant,

• a partnership of a school of nursing such and facility, or

• a partnership of such a program and facility

Faith-based and community-based organizations, Tribes, and tribal organizations may apply if otherwise eligible.

In addition to the 50 states, only the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply.

All eligible applicants must be accredited. In Attachment 10 the applicant organization must provide: (1) a statement that they hold accreditation from the relevant accrediting body and are not under probation, and (2) the dates of the initial accreditation and next expected accrediting body review. The full letter of accreditation is not required.

Recipients must immediately inform the HRSA project officer of any change in accreditation status. If a partner institution holds the accreditation for a training program, a letter of agreement should be provided as well.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Programmatic Responsiveness Provide evidence that the project director is at least a masters-prepared health professional or masters-prepared health educator who is also a geriatrics or gerontology specialist (except for project directors of CNA programs who must be at least bachelor’s-level prepared), and has a minimum of five years of experience in leading geriatrics initiatives including workforce development. HRSA will consider any

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application that does not meet this requirement non-responsive and will not consider it for funding under this notice.

Ceiling Amount

This award has a ceiling amount of $750,000. At least $100,000 must be for ADRD activities. HRSA will consider any application that exceeds the overall $750,000 annual ceiling amount or that exceeds $650,000 each year for non-ADRD activities non-responsive and will not consider it for funding under this notice.

Deadline

The deadline for applications is February 6, 2019 at 11:59 p.m. Eastern Time. HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

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 Sections 797(b) and 803(b) of the Public Health Service Act. Complete the Maintenance of Effort information document and submit as Attachment 7.

Multiple Applications

NOTE: Multiple applications from an organization with the same DUNS number are allowable if the applications propose separate and distinct projects. However, no more than one application per organization or campus will be funded.

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.

Student/trainee/fellow/faculty eligibility requirements A student/trainee/fellow/faculty receiving support from award funds must be a citizen of the United States, a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national.

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this NOFO following the directions provided at https://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

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. You must submit the applications in the English language and 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 80 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 workspace application package do NOT count in the page limit. Biographical Sketches do count in the page limit.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count 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.

https://www.grants.gov/ https://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html 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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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 11: 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), include the following:

i. Project Abstract

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

In addition to the instructions provided in the guide, please include the following information at the top of the abstract:

• Period of performance

• The name and credentials of the project director

• The name of the applicant organization

• Names and types of partners (academic program, primary care delivery sites or systems, community-based organization)

• Trainee types–patients, families, caregivers, direct care workers, healthcare providers and health professions students, residents, fellows, and faculty

• State if your application is new or a competing continuation

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 for which funding is requested will be accomplished, i.e., the "who, what, when, where, why and how" of a project;

4. Special populations targeted;

5. Patient outcomes targeted; and

6. A clear statement about which Funding Preference is being requested, if applicable. Justification is to be provided in Attachment 8.

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ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, 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

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that trainees would ultimately serve:

• Briefly describe the purpose of your proposed project and the gaps to be filled;

• Describe the population(s) served by your project and their unmet health needs including their unmet social determinants of health needs; (Note:

competing continuation applicants must propose new community-based primary care sites in addition to and/or in place of existing GWEP sites in order to promote impact and spread to new communities);

• Describe the unmet education and training needs of the workforce that will participate in this project;

• Provide national, state, and local health status indicators related to your target population(s) in the defined area; and

• Describe how the healthcare of older adults and their health outcomes will be improved through this project.

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

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

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

You must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope (a sample work plan can be found here: http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.).

You must:

• Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section;

• Describe the timeframes, deliverables, and key partners required during the period of performance to address each of the needs described in the Purpose and Need section;

• Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of project implementation;

• Identify meaningful support and collaboration with key partners in planning, designing and implementing all activities, including development of the http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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application and, further, the extent to which these contributors reflect the diversity of the populations and communities served;

• Describe how specific telehealth modalities are appropriate for the training of the workforce, including, if applicable, teleprecepting, telementoring and/or project ECHO, will be used to provide training and education; and

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

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

Propose methods that you will use to address the stated needs and meet each of the previously described program goals and objectives this NOFO. Applicants must develop and operate a program for the training of health professions students, residents, and fellows who will provide healthcare to older adults, the faculty who train these individuals, primary care providers, direct care workers, as well as patients, families, and caregivers to improve health outcomes for older adults. Training must focus on the integration of geriatrics and primary care, not acute care.

The applicant organization must include or partner with the following:

1. An academic geriatrics training program (training can occur within academic health centers; however, these sites do not satisfy the community-based primary care site partner requirement);

2. One or more community-based primary care sites. Applicants are encouraged to partner with health centers, rural health clinics, and Indian Health Service Tribal, and Urban Indian Health programs. Competing continuation applicants must propose new community-based primary care sites in addition to and/or in place of existing GWEP sites in order to promote impact and spread to new communities; and

3. Community-Based Organizations. Applicants are encouraged to partner with Area Agencies on Aging, Alzheimer’s Association chapters, faith-based organizations, senior centers, and other organizations that provide services and support to keep older adults in their homes and communities and family caregiver support.

Required partnerships must be reciprocal, with multidirectional sharing of knowledge and skills and shared decision-making across partners. You may propose reciprocal partnerships with entities that are not in your same geographic area, state, or HHS region (https://www.hhs.gov/about/agencies/iea/regional-offices/index.html). The proposed project should be supported by all partners;

maximize complementary skills and knowledge across partners; create synergisms to produce results that no one partner could have achieved alone;

have recognized and consistent leadership and a dedicated core of interprofessional staff; have adequate resources for implementation and evaluation; plan for dissemination to other communities; and identify community-

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based geriatrics change-agents to maintain any progress obtained during the partnership.7

In addition to the required partnerships, you are encouraged to partner with other organizations and programs that impact health outcomes for older adults, including nursing homes, prisons, elder justice programs (e.g., programs that are designed to prevent, intervene, and/or remedy the effects of elder abuse), healthy aging programs, Dementia Friendly America programs, National Institute on Aging funded Alzheimer’s Disease Centers, Area Health Education Centers, health plans, state and local health departments, Quality Improvement Organizations, Department of Veterans Affairs, and Department of Labor apprenticeship programs.

In the Methodology section of your application, you must:

• Describe how you will address the program objectives listed in Section I (including your activities and methods). Your approach to these objectives should be specific, measurable, realistic, and achievable within the period of performance;

• Propose methods that you will use to address the objectives including the roles of partners, system level initiatives, the educational/teaching strategies to be implemented, and curricula/training materials that will be used to accomplish the objectives of the project;

• Describe how your project is innovative and will prepare the workforce to practice in integrated geriatrics and primary care delivery sites/systems that are age friendly and/or communities that are dementia friendly;

• Competing continuation applicants must describe your proposed new community-based primary care sites that you will partner with in addition to and/or in place of existing GWEP sites;

• Describe the types and numbers of trainees you expect to train through the project activities during the period of performance. Include descriptions of any planned traineeships, fellowships, or faculty training awards. Discuss any selection criteria for trainees, if applicable; and

• Demonstrate how enhancing existing, or developing new, reciprocal partnerships aimed at establishing and supporting training experiences will provide integrated healthcare for older adults while promoting age-friendly sites or systems and dementia-friendly communities.

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. Information about logic models may be found in Section VII of the NOFO. For the purposes of this notice, the logic model should summarize the connections between the:

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

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

7 Heaton, J., Day, J., & Britten, N. (2016). Collaborative research and the co-production of knowledge for practice: An illustrative case study. Implementation Science, 11(20). Published online 2016 Feb 20

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• 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 Work Plan, which summarizes the work plan components, must be uploaded into Attachment 1. The Logic Model must be uploaded into Attachment 3.

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 two 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 that will contribute to value-based care delivery and continuous quality improvement. 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. (In the Attachments section (IV. 2. v., Attachment 2), you must attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form.

You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

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

http://bhw.hrsa.gov/grants/reporting/index.html. Describe the data collection strategy to collect, manage, analyze, and track data (e.g., assigned skilled staff, data http://bhw.hrsa.gov/grants/reporting/index.html

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management software) to measure process and impact/outcomes, and explain how 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. Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature. Describe your process to collect National Provider Identifier (NPI) of students who receive stipend/traineeship funds for the purpose of collecting post-graduation employment demographics. You must describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements 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.

You must include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting project goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections. Additional information on RCQI is available at the following website:

http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

Program Impact Evaluation

You must include an evaluation plan to show program impact for patient access, quality, and cost measures in at least five (5) identified measures. The following three (3) CMS Merit-Based Incentive Payment System (MIPS) standardized measures (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityMeasures/index.html) are required for all applicants:

• MIPS MEASURE 1: Dementia Caregiver Education and Support:

Percentage of patients, regardless of age, with a diagnosis of dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND referred to additional resources for support within a 12 month period.

• MIPS MEASURE 2: Evaluation or Interview for Risk of Opioid Misuse: All patients 18 and older prescribed opiates for longer than six weeks duration evaluated for risk of opioid misuse using a brief validated instrument (e.g., Opioid Risk Tool, Screener and Opioid Assessment for Patients with Pain- Revised [SOAPP-R]) or patient interview documented at least once during Opioid Therapy in the medical record.

• MIPS MEASURE 3: Care Plan: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html

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was not able to name a surrogate decision maker or provide an advance care plan.

For the additional two (2) required patient outcome measures, you are encouraged to use existing measures, such as:

Medication measure:

• MIPS: Use of High-Risk Medications in the Elderly: Percentage of patients 66 years of age and older who were…