PKG00246476-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Primary Care Training and Enhancement:

Integrating Behavioral Health and Primary Care Program

Funding Opportunity Number: HRSA-19-086 Funding Opportunity Type: New

Catalog of Federal Domestic Assistance (CFDA) Number 93.884

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: January 28, 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 27, 2018

Program Contact: Nancy V. Douglas-Kersellius Nurse Consultant, MTGB/DMD Telephone: (301) 443-0907 Fax: (301) 443-0162

Email: ndouglas@hrsa.gov

Authority: Section 747(a) of the Public Health Service (PHS) Act (42.U.S.C. 293k(a))

HRSA-19-086 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2019 Primary Care Training and Enhancement (PCTE): Integrating Behavioral Health and Primary Care (IBHPC) Program. The purpose of the PCTE:

IBHPC Program is to fund innovative training programs that integrate behavioral health care into primary care, particularly in rural and underserved settings with a special emphasis on the treatment of opioid use disorder. The PCTE: IBHPC is a component of the Primary Care Training and Enhancement (PCTE) Program, which functions to strengthen the primary care physician and physician assistant workforce by supporting enhanced training for future and current primary care clinicians, teachers, and educators and to promote primary care practice.

Funding Opportunity Title: Primary Care Training and Enhancement:

Integrating Behavioral Health and Primary Care

Funding Opportunity Number: HRSA-19-086

Due Date for Applications: January 28, 2019

Anticipated Total Annual Available FY 2019 Funding:

$4,000,000

Estimated Number and Type of Award(s): Up to 10 grant(s)

Estimated Award Amount: Up to $250,000 for single projects;

Up to $400,000 for collaborative projects, per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: July 1, 2019 through June 30, 2024 (5 years)

Eligible Applicants: Eligible applicants must be accredited schools of allopathic or osteopathic medicine, academically affiliated physician assistant training programs, or accredited public or nonprofit private hospitals, or a public or nonprofit private entity that the Secretary has determined is capable of carrying out such grants.

Faith-based and community-based organizations, tribes and tribal organizations may apply for these funds, if otherwise eligible.

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

HRSA-19-086

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 pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) 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 https://bhw.hrsa.gov/fundingopportunities/

HRSA-19-086

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 ELIGIBILITY INFORMATION

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

HRSA-19-086 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Primary Care Training and Enhancement (PCTE): Integrating Behavioral Health and Primary Care (IBHPC) Program.

Program Purpose The purpose of the PCTE: IBHPC Program is to fund innovative training programs that integrate behavioral health care into primary care, particularly in rural and underserved settings with a special emphasis on the treatment of opioid use disorder. The PCTE:

IBHPC is a component of the PCTE Program which functions to strengthen the primary care physician and physician assistant workforce by supporting enhanced training for future and current primary care clinicians, teachers, and educators and to promote primary care practice in underserved areas.

Program Objectives The PCTE: IBHPC Program objectives support the U.S. Department of Health and Human Services (HHS) and Health Resources and Services Administration (HRSA) priority around combatting the opioid crisis as well as HRSA’s priorities around enhancing access to mental health services and transforming the health workforce by targeting the need. Specifically, the objectives for the PCTE: IBHPC are:

1. Enhance primary care training in integrated behavioral health and primary care and advance primary care clinical training sites using the Framework for Levels of Integrated Healthcare1;

2. Initiate new or enhance existing training in opioid and other substance use disorders, including clinical experiences in opioid and other substance use disorders, Medication Assisted Treatment (MAT), and enhancements to the clinical training sites and faculty development as needed; and

3. Develop and implement a systematic approach to improve trainee and provider wellness.

Applicants should be committed to developing a diverse and inclusive health workforce that reflects the populations they serve, and applicants are encouraged to provide interprofessional education and practice.

1 https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf

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Additional Program Information

Funding Preference This notice includes a funding preference (section 791(a)(1) of the Public Health Service (PHS) Act for applicants that:

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

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

Refer to Attachment 7 and Section V.2 of this NOFO for detailed information on qualifying for a funding preference.

2. Background

The mission of HRSA’s Bureau of Health Workforce (BHW) is to improve the health of the underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. BHW is committed to ensuring that the U.S. has the right clinicians, with the right skills, working where they are needed most.

The PCTE Program is authorized by Title VII, Section 747(a) of the PHS Act.

As a component of the PCTE Program, the PCTE: IBHPC Program facilitates the overarching purpose of the PCTE Program to strengthen the primary care workforce by supporting enhanced training for future primary care clinicians, educators and researchers and to promote primary care practice, particularly in rural and underserved areas.

Research shows that a strong primary care foundation is critical for healthcare system performance and improved health.2,3 Recent evidence also suggests that the primary care workforce is associated with higher quality care at lower spending.4 The National Center for Health Workforce Analysis projects that the total demand for primary care physicians will grow by 38,320 Full Time Equivalent (FTE) positions between 2013 and 2025. It is estimated that there will be a shortage of 23,640 primary care physician FTEs by 2025. In addition to overall shortages, there is maldistribution of primary care providers with rural and other underserved communities experiencing the greatest shortages.5 HRSA has long recognized the importance of training primary care physicians and physician assistants to become effective clinicians, teachers, researchers, and leaders. The PCTE programs help produce high quality, diverse

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

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

4 Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Affairs. 2004. Available at: https://pdfs.semanticscholar.org/a172/cc261cc5d92b563507a2edc62cdca2b8eb5c.pdf 5 HRSA. Projecting the supply and demand for primary care practitioners through 2020. HRSA. 2013. Available at:

https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020 https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf https://pdfs.semanticscholar.org/a172/cc261cc5d92b563507a2edc62cdca2b8eb5c.pdf https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020

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primary care clinicians who will be able to address the Nation’s health care needs, particularly in communities of high need. There is evidence that physicians who receive training in community-based and underserved settings are more likely to practice in similar settings, such as health centers.6,7

Behavioral healthcare is the continuum of services for persons at risk of or are suffering from mental, behavioral, or addictive disorders, such as post-traumatic stress disorder, substance use disorders, and depression.8 Behavioral health issues are the leading cause of disabilities that contribute to rising healthcare in the United States.9 Mental illness knows no age; it affects over 18% of adults and 13% to 20% of children ages 8- 15 years old.10 It is also reported that severe depression increased in youth from 5.9% in 2012 to 8.2% in 2015.11 Illicit drug use is prevalent in approximately 9.4% of the population 12 and older, with 6.3% of the population being heavy users of alcohol defined as five or more drinks on each of five or more days in the past 30 days.12 It’s reported that one in four persons on long term opioid therapy in primary care settings struggle with opioid use disorder; approximately 116 persons are dying daily from an opioid related overdose.13 Primary care settings are usually the first point of access for prevention, assessment and intervention.

Compounding these behavioral health and substance use disorder issues are significant behavioral health disparities in underserved communities. These disparities may be due to lack of access to health care, need for a diverse health care workforce, a lack of information, and the need for culturally and linguistically competent care and programs.14 HRSA works to address the need for the healthcare workforce in these areas by increasing the numbers of adequately and culturally prepared health professionals ready to practice.

Patients requesting care from their primary care provider usually present with a chief complaint of physical illness, however, data suggest that there is often an underlying mental health or substance use issue triggering the visit.15 Approximately, 70% of

6 Phillips RL, Petterson S, Bazemore, A. Do residents who train in safety net settings return for practice? Academic Medicine. 2013; 88(12): 1934–1940.

7 Goodfellow A, Ulloa J, Dowling P, et al. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Academic Medicine. 2016; 91(9):

1313–1321 8 Behavioral Health, 2016-2017, TECHNICAL REPORT, August 28, 2017, National Quality Forum, This report is funded by the Department of Health and Human Services under contract HHSM-500-2012-00009I Task Order

HHSM-500-T0008.

9 Behavioral Health, US 2012 report 10 The State of mental health in America, 2018) (Mental Health Facts, Stats, and Data, The State of Mental Health in America 2018) 11 Ibid 12 Gerrity, Martha. Integrating Primary Care into behavioral health settings: what works for individuals with serious mental illness, page 4 13 U.S. Department of Health and Human Services, What is the U.S. Opioid Epidemic? Retrieved August 21, 2018 from https://www.hhs.gov/opioids/about-the-epidemic/index.html 14 Substance Abuse and Mental Health Services Administration. (n.d.). Health Disparities. Retrieved July 17, 2018, from https://www.samhsa.gov/health-disparities.

15 Chris Collins, Denise Levis Hewson, Richard Munger, and Torlen Wade, Evolving Models of Behavioral Health https://www.hhs.gov/opioids/about-the-epidemic/index.html https://www.samhsa.gov/health-disparities

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primary care visits are the result of psychosocial problems.16 Primary care providers are not adequately educated to address these issues, as there is the tendency to misdiagnose, underdiagnose or fail to diagnose.17

The primary care provider’s ability to competently assess and provide treatment for behavioral health conditions will enhance the primary care practice, improve behavioral health access, and promote value-based care. Provider burnout can jeopardize the quality of care and access to care that clients receive. Therefore, attention to provider wellness is essential. Burnout among students and practitioners in all health professions is a serious and growing problem.18 The impact of burnout is insidious and can have a long-term impact on the professions and the workplace, with both immediate and long-term costs.19 To help address student and provider burnout education is needed throughout the healthcare system. The healthcare system can benefit from reduced burnout through improved worker satisfaction and reduced turnover, lower costs, and improved patient safety and satisfaction.20

II. Award Information

1. Type of Application and Award

Type of applications sought: New. HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $4,000,000 to be available annually to fund approximately 10 recipients. You may apply for a ceiling amount of up to $250,000 per year for a single project, or up to $400,000 per year for an interprofessional collaborative project.

Total cost includes both direct and indirect, facilities and administrative costs.

You have the option to apply for either a single or a collaborative project, but not both.

If you meet the definition of, and qualify as a collaborative project, you may apply for the higher funding ceiling in recognition of the additional costs associated with providing interprofessional training and experiences for primary care trainees.

The period of performance is July 1, 2019 through June 30, 2024 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for the PCTE:

IBHPC Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

Integration in Primary Care, Milbank Memorial Fund, 645 Madison Ave., New York, New York 10022. 2010. ISBN 978-1887748-73-5.

16 Ibid 17 (Fagri, Boisvert, & Faghri, Understanding the expanding role of primary care physicians to primary care psychiatric care physicians: enhancing the assessment and treatment of psychiatric conditions, Mental Health in Family Medicine, 2010).

18 Issue Brief: 15th Annual Report of the Advisory Committee on Training in Primary Care Medicine and Dentistry.

Reducing Burnout Among Healthcare Providers: Managing Stress, Building Resilience, and Promoting Well-Being 19 Ibid 20 Ibid

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

Limitations on indirect cost rates 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 for equipment, tuition and fees, and sub-awards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

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

The lead applicant training programs for this NOFO must be from one of the following professions or disciplines: family medicine, general internal medicine, general pediatrics, medical students, physician assistant students, or faculty in any of these areas.

Foreign entities are not eligible for HRSA awards, unless the authorizing legislation specifically authorizes awards to foreign entities or the award is for research. This exception does not extend to research training awards or construction of research facilities.

The applicant must submit accreditation documentation for the lead applicant training program in Attachment 4. The lead applicant training program must be a medical school, academically affiliated physician assistant training program, or residency program in family medicine, internal medicine, or pediatrics. The project director must be from the profession and discipline of the lead applicant training program. Provisional accreditation is acceptable for new programs.

Required Eligibility Documentation The applicant organization must provide: (1) a statement that they hold initial or continuing accreditation from the relevant accrediting body and are not on probation, and (2) the dates of initial accreditation and next expected accrediting body review. The full letter of accreditation is not required. Documentation of accreditation must be provided for all training programs included in the collaborative project proposals. Award recipients must immediately inform the HRSA project officer of any change in 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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accreditation status. If a partner organization holds the accreditation for a training program, a letter of agreement must be provided in Attachment 4.

Collaborative Project Documentation In addition to your accreditation documentation, you must

1) include a statement on the accreditation status for all other training programs involved in your collaborative project in Attachment 4; and

2) include a letter of agreement or memorandum of understanding (MOU) that provides documentation that project activities target at least two training levels (student, resident, faculty development, and practicing primary care physician or physician assistants) and at least two primary care professions in Attachment 3.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other Eligibility Information

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $250,000 for single projects and $400,000 for collaborative projects as non-responsive and will NOT consider it for funding under this notice.

Deadline 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 that is not less than expenditures for such activities during the fiscal year prior to receiving the award, as required by Section 797(b) of the Public Health Service Act.

Complete the MOE information and submit as Attachment 6.

Multiple Applications Multiple applications from an organization are allowable. However, only one award will be made per organization. Separate organizations are those entities that have unique DUNS numbers.

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

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive. Applications received without the appropriate eligibility documents will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

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

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. 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 application 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 65 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the 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.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

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

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

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

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

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

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

Provide project title, organization name and the project director at the topic of the abstract.

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 HHS and HRSA clinical priorities of mental illness, opioid use disorder, and/or value–based/quality care will be addressed by the project, as applicable;

4. 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;

5. Clearly identify if this is a single or collaborative project and identify the lead applicant training program and any interprofessional training program partners, as appropriate. Include the disciplines and training levels of the collaborative projects; and

6. A clear statement about which Funding Preference is being requested, if applicable. Justification is to be provided in Attachment 7.

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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

First, briefly describe the purpose of the proposed project. Describe the need for primary care physician and physician assistant trainees to acquire education and skills in the integration of behavioral health and primary care.

Describe the clinical training sites that will be enhanced through this project, including the demographics, social determinants of health, health disparities and behavioral health, including incidence of substance used disorder of the population served, including any vulnerable populations served, such as rural, medically underserved, and veterans. Use and cite demographic data whenever possible to support the information provided. Describe how your proposed project is expected to improve health care for the populations described.

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

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 grant 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 grant implementation.

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

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

If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented, and that the activities are related to the proposed project.

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

#2 (b).

For collaborative projects: describe what aspects of collaboration are being implemented.

Describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Objectives must be specific, measurable, achievable, relevant, and timely.

Describe the key activities for enhancing training in integrated behavioral health and primary care, including any enhancements to the clinical training sites.

Identify where the primary care clinical training sites are using the Framework for Levels of Integrated Healthcare21 and describe how the project will move the primary care clinical training sites to a higher level.

Describe your plan to enhance training and clinical experiences, in the primary care clinical training sites in opioid and substance use disorders, including in Medication Assisted Treatment (MAT).

Describe any plans to address the integration of evidence-based trainings for health professionals to screen, assess, intervene, and refer patients to specialized treatment for mental illness.

Describe your plan to address trainee and provider wellness in your project.

Provide evidence and/or identify resources for training tools and best practices that support your proposed activities. Examples of resources include the HRSA-funded National Center for Integrated Behavioral Health, National Institute on Mental Health, Describe why your project is innovative. Examples of resources include The Academy for Integrating Behavioral Health and Primary Care (The Academy) and The Integrated Practice Assessment Tool.

Provide a training chart of the number of trainees to be trained, by profession/disciple, training year and projected number of graduates.

Logic Model You must submit a logic model (Attachment 8) for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this NOFO the logic model should summarize the connections between the:

21https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf https://ncibh.org/ https://ncibh.org/ https://www.nimh.nih.gov/index.shtml https://www.nimh.nih.gov/index.shtml https://integrationacademy.ahrq.gov/about-ahrq-academy https://integrationacademy.ahrq.gov/about-ahrq-academy http://ipat.valueoptions.com/IPAT/ https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf

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

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

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

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

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

Outputs (i.e., the direct products or deliverables of program activities); and Outcomes (i.e., the results of a program, typically describing a change in people or systems).

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

For the opioid and substance use disorder training and clinical training site enhancement activities, your evaluation plan must assess any increases in treatment of opioid and substance use disorders, quality of care, and MAT certifications.

You must be able to provide baselines for these measures and are encouraged to match your evaluation measures to existing measures. For example:

The Centers for Medicare and Medicaid Merit-based Incentive Payment System includes the following measures:

Documentation of Signed Opioid Treatment Agreement: All patients 18 and older prescribed opiates for longer than six weeks duration who signed an https://qpp.cms.gov/mips/explore-measures/quality-measures

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opioid treatment agreement at least once during Opioid Therapy documented in the medical record.

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, SOAPP-R) or patient interview documented at least once during Opioid Therapy in the medical record.

The Bureau of Primary Health Care Uniform Data System includes the following:

The number of physicians, certified nurse practitioners and physician assistants, on-site or with whom the health center has contracts, have obtained a Drug Addiction Treatment Act of 2000 (DATA) waiver to treat opioid use disorder with medications specifically approved by the U.S. Food and Drug Administration (FDA) for that indication.

The number of patients who received medication-assisted treatment for opioid use disorder from a physician, certified nurse practitioner, or physician assistant, with a DATA waiver working on behalf of the health center.

Programs will be required to report on their evaluation progress and findings in their annual Progress Report. Additional technical assistance resources for developing an evaluation plan are available at:

https://bhw.hrsa.gov/grants/medicine/primary-care-training-enhancement-grantee-evaluation-resources

You must include a plan for continuous quality improvement, such as Rapid Cycle Quality Improvement (RCQI), for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant 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/.

You also must describe the systems and processes that will support your organization's collection of HRSA’s performance measurement data, as required 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 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.

For implementation of the program performance evaluation and HRSA’s performance measures requirements, describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. Describe plans for https://bhw.hrsa.gov/grants/medicine/primary-care-training-enhancement-grantee-evaluation-resources https://bhw.hrsa.gov/grants/medicine/primary-care-training-enhancement-grantee-evaluation-resources http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://bhw.hrsa.gov/grants/reporting/index.html

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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.

Describe your process to track trainees after program completion/graduation for up to one year, to include collection of trainees’ National Provider Identifiers (NPI). (Note: Trainees who receive HRSA funds as a result of this award are encouraged to apply for an NPI for the purpose of collecting post-graduation employment demographics).

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b) You must provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding, as well as (c) provide a timetable for becoming self-sufficient. Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. You must discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations. (A project organizational chart is requested in Section IV.2.v, Attachment 5.) Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings. Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

A project organizational chart is requested in Attachment 5. This chart should delineate the relationships, roles, and responsibilities of all partner organizations, including primary care clinical training sites and interprofessional training program partners.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 2 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile form that can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a

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letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

Biographical sketches, not exceeding two pages per person, should include the following information:

Senior/key personnel name

Position Title

Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

Section a (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal advisory committee.

Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

Section D (optional) Other Support. List both selected ongoing and completed (during the last 3 years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

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NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Narrative Section Review Criteria

Purpose and Need (1) Purpose and Need

Response to Program Purpose:

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources and Capabilities

(4) Organizational Information, Resources and Capabilities

Budget and Budget Narrative (below)

(5) Support Requested – the budget section should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

iii. Budget

See Section 4.1.iv of HRSA’s SF-424 R&R Application Guide. Please note: the directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov. Follow the instructions included the R&R Application Guide and the additional budget instructions provided below. A budget that follows the R&R Application Guide will ensure that, if HRSA selects the application for funding, you will have a well-organized plan, and by carefully following the approved plan can avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

In addition, the PCTE: IBHPC program requires the following, which corresponds to Section V’s Review Criterion 5 - Support Requested.

The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-245), Division B, § 202 states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Please see Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 R&R Application Guide for additional information. Note http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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that these or other salary limitations may apply in the following fiscal year, as required by law.

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 for equipment, tuition and fees, and sub-grants and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

iv. Budget Justification Narrative

See Section 4.1.v. of HRSA’s SF-424 R&R Application Guide. In addition, the Primary Care Training and Enhancement program requires the following:

Collaborative Projects: Applicants that propose a collaborative project as described in Section IV Project Narrative must include a budget table within the budget justification that provides a specific budget breakdown for each collaborative partner(s) and for each of the proposed disciplines/professions by training levels for each budget year. The budget breakdown must provide the line items for each discipline for each budget year.

Evaluation Costs: Applicants may request funding to support annual reporting requirements (i.e., software, personnel time, etc.), and to conduct the required program evaluation as described in this funding opportunity announcement. Applicants must ensure adequate resources are requested to conduct an evaluation that meets the requirements as outlined in Section IV.

Participant/Trainee Support Costs: For applicants with participant/trainee support costs, list tuition/fees/health insurance, stipends, travel, subsistence, other, and the number of participants/trainees. Ensure that your budget breakdown separates these trainee costs, and includes a separate sub-total entitled “total Participant/Trainee Support Costs” which includes the summation of all trainee costs. Trainee costs must be delineated by profession/discipline trained to be complete.

Stipends may only be used for cost of living expenses during the period of training.

Other educational expenses (such as tuition, travel, and conference fees) should be itemized and justified apart from any planned stipend allotment. Stipends are not allowable for medical residents or medical students. Physician assistant students are eligible to receive a stipend.