PKG00246807-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Advanced Nursing Education Nurse Practitioner Residency (ANE-NPR) Program

Funding Opportunity Number: HRSA-19-001

Funding Opportunity Type: Initial, New

Catalog of Federal Domestic Assistance (CFDA) Number 93.247

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: March 4, 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: December 11, 2018

Debra A. Parchen, MSN, RN Nurse Consultant / Project Officer Telephone: (301) 443-2597 Fax: (301) 443-0791

Email: ANE-NPR@hrsa.gov

Authority: Section 811 of the Public Health Service Act (42 U.S.C. 296j) mailto:ANE-NPR@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2019 Advanced Nursing Education-Nurse Practitioner Residency (ANE-NPR) Program. The purpose of this program is to prepare new nurse practitioners (NPs) in primary care practice in community-based settings through clinical and academic focused 12-month Nurse Practitioner Residency (NPR) programs with a preference for those projects that benefit rural or underserved populations. For this program, NP specialties that have a primary care focus may include: Family, Adult Family, Adult-Gerontology, Pediatric, Women’s Health Care, Nurse Midwife, Psychiatric- Mental Health, and Psychiatric-Mental Health Family. This FY 2019 ANE-NPR Program Notice of Funding Opportunity (NOFO) seeks to increase primary care providers in community-based settings.

Funding Opportunity Title: Advanced Nursing Education NPR (ANE- NPR) Program

Funding Opportunity Number: HRSA-19-001

Due Date for Applications: March 4, 2019

Total Annual Available FY 2019 Funding:

$20,000,000

Estimated Number and Type of Award(s): Approximately 20 grant(s) with a maximum of 8 awards under Track 1 and a maximum of 20 under Track 2

Estimated Award Amount: Track 1 - Development and Start-Up: Up to $500,000 in year one; up to 1,000,000 in years 2, 3 and 4.

Track 2 - Enhancement and/or Expansion: Up to $1,000,000 per year

All are subject to the availability of appropriated funds.

Cost Sharing/Match Required: No

Period of Performance: July 1, 2019 through June 30, 2023 Four (4) years

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Eligible Applicants: Eligible applicants are schools of nursing, nurse managed health clinics/centers, academic health centers, state or local governments and other private or public nonprofit entities determined appropriate by the Secretary. Consortia of public or private nonprofit entities that confer degrees, or provide practice support to RNs for NP education in primary care or other such private or public nonprofit entities are eligible to apply under this funding opportunity. For purposes of this NOFO, a consortium should consist of at least three independent organizations that meet the above qualifications.

For-profit entities are not eligible under this NOFO.

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

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/

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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 Program-Specific Forms

vi. 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 (FY) 2019 Advanced Nursing Education Nurse Practitioner Residency (ANE-NPR) Program.

Program Purpose The purpose of this program is to prepare new nurse practitioners (NPs) in primary care for practice in community-based settings through clinical and academic focused 12-month Nurse Practitioner Residency (NPR) programs, with a preference for those projects that benefit rural or underserved populations.

Program Goals The ANE-NPR Program Notice of Funding Opportunity (NOFO) seeks to increase primary care providers in community-based settings. This program has been structured in a way so that training programs are encouraged to support the placement of participants in rural and underserved settings and also find ways to assist NP graduates to remain in these settings.

Program Objectives The ANE-NPR Program offers two tracks based upon applicant readiness. You may submit a proposal as:

1) Track 1 - Development and Start-Up: an applicant that needs up to a 12 month start-up period to develop and implement an ANE-NPR Program by no later than the start of year two; or

2) Track 2 - Enhancement and/or Expansion: an applicant that is ready to launch an active ANE-NPR Program with participants, or that has the ability to enhance and/or expand their existing NPR Program, particularly in rural or underserved areas.

Program Priorities Applicants are required to address their use and adoption of telehealth and other health care technology, as applicable, which increase readiness to practice and prepare advanced NPs in primary care to expand access to high quality care where it’s most needed.

Applicants are encouraged to select and address one of the priorities below which include the United States Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) priorities as they relate to the following:

Combatting the opioid crisis/Mental Health

Value-based care delivery and quality improvement initiatives

Transforming the workforce –targeting the need

Telehealth

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Childhood obesity Maternal Mortality

* If your application discusses opioids as a priority, HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, TA, and training, visit here: https://www.hrsa.gov/opioids.

2. Background Under the Public Health Service (PHS) Act section 811(a), HRSA is authorized to support projects that support the enhancement of advanced nursing education and practice.

The demand for primary care services has increased largely due to both a growing population and an aging population. HRSA’s National Center for Health Workforce Analysis projects the demand for primary care physicians will increase by 38,320 full time employees (FTEs) constituting a 17 percent increase (from 224,780 FTEs in 2013 to 263,100 FTEs in 2025). 1 This projected demand in primary care services would result in a shortage of 23,640 physicians needed to provide primary care.2 Expanding the role of advance practice registered nurses is anticipated to help meet this need for primary care services.

Improving access to primary care providers, like doctors and advance practice registered nurses, is especially important in rural and underserved areas. Rural areas also have proportionally fewer providers in occupations that require more education and training.3 In addition, these areas often face significant health challenges and health disparities.4 Addressing the gap in primary care providers for rural and underserved populations is of the utmost importance for the health of the Nation. Nurses, specifically NPs in primary care, can help to address this gap, especially when they are working at the top of the scope of licensure.5

1 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. Rockville, Maryland. Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf.

2 Id.

3 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Distribution of U.S. Health Care Providers Residing in Rural and Urban areas.

Rockville, Maryland: U.S. Department of Health and Human Services, 2014.Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/nchwafactsheet.pdf.

4 Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W.

(2015). Rural Healthy People 2020: New Decade, Same Challenges. The Journal of Rural Health, 31, 326–333. doi:10.1111/jrh.12116 5 Recruiting and Maintaining U.S. Clinical Training Sites: Joint Report of the 2013 Multi-Discipline Clerkship/Clinical Training Site Survey (2014). Retrieved from https://members.aamc.org/eweb/upload/13-225%20WC%20Report%202%20update.pdf https://www.hrsa.gov/opioids 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://bhw.hrsa.gov/sites/default/files/bhw/nchwa/nchwafactsheet.pdf https://members.aamc.org/eweb/upload/13-225%20WC%20Report%202%20update.pdf

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The National Academy of Sciences recommends establishing ways to develop and finance nursing residency programs, which provide a bridge to practice.6 NPs are expected to carry a full provider patient load upon graduation and after obtaining licensure/certification. Providing care for rural and underserved populations involves complexities and can be challenging for a new NP transitioning to practice in a rural and underserved setting.7,8 Information from the health care field notes that NP’s are often overwhelmed and unable to carry the expected full patient care load upon acquiring their first employment, especially with these populations.9 The ANE-NPR Program facilitates the development of rigorous primary care clinical practice residencies to increase and fortify clinical knowledge and skills and provides an advantageous transition to practice. NPRs will allow for the additional opportunity to increase and fine tune health care skills with the presence and guidance of a preceptor. Further, a residency with an academic affiliation will enable the development and standardization of curricula and competencies.10

For states requiring a transition to practice period, the NPR Program may meet this requirement (assuming it meets all the documented requirements outlined in this NOFO, i.e., community-based academic partnership providing primary care, with a preference for those serving rural and/or underserved populations) based on the preceptorships and oversight provided during the residency rotation.

The lower concentration of NPs in rural and underserved areas contributes to the challenges of meeting the health needs of these populations, who have complex healthcare needs requiring primary care providers who are knowledgeable and skilled.11 Published research suggests that medical students who have clinical experiences in rural settings tend to remain to care for these populations.12 Although more limited research on nursing is available, post-graduation rural employment by nursing students seems to be linked to life experiences in and connections to small communities as well as exposure to rural practice settings during training.13 Graduate nursing students who

6 National Academies of Sciences, Engineering, and Medicine. (2016). Assessing Progress on the Institute of Medicine Report: The Future of Nursing. Washington, DC: The National Academies Press.

https://doi.org/10.17226/21838 .

7 Flinter, M., & Hart, A. M. (2017). Thematic elements of the postgraduate NP residency year and transition to the primary care provider role in a Federally Qualified Health Center. Journal of Nursing Education and Practice, 7(1), 95-106.

8 Rieselbach, R. E., Crouse, B. J., & Frohna, J. G. (2010). Health centers: Addressing the workforce crisis for the underserved. Annals of Internal Medicine, 152, 118-22.

9 Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. Retrieved from https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf 10 Harper, D., McGuinness, T., Johnson, J. (2017). Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation? Nursing Outlook, 65(1), pp. 50-57. doi:

10.1016/j.outlook.2016.08.004 11 Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. Retrieved from https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf 12 Farmer, J., Kenny, A., McKinstry, C., & Huysmans, R. D. (2015). A scoping review of the association between rural medical education and rural practice location. https://doi.org/10.1186/s12960-015-0017-3 13Bushy A, Leipert BD. Factors that influence students in choosing rural nursing practice: a pilot study.

Rural Remote Health. 2005 Apr-Jun;5(2):387. Epub 2005 Apr 19.

https://doi.org/10.17226/21838 https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf https://doi.org/10.1186/s12960-015-0017-3

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attended a program with a rural focus seem to be more likely to practice in rural areas.14 As such, assuring the required skill set and addressing the maldistribution of clinicians can be addressed through a NPR Program.

Program Definitions

The Health Workforce Glossary contains general definitions for terms used throughout the Bureau of Health Workforce NOFOs. In addition, the following definitions apply to the ANE-NPR Program for Fiscal Year 2019.

Consortium – An association or agreement of at least three separately owned and governed, public or private nonprofit entities that confer degrees or provide practice support, formed to undertake an enterprise beyond the resources of any one member.

A consortium has a clearly documented, binding agreement of resource support and roles/responsibilities. Consortiums are able to align resources and strategies, achieve economies of scale and efficiency, and address challenges more effectively as a group than as single entities. For the purposes of this program, the consortium applicant is the entity that meets the program’s eligibility criteria in Section III.1 of the NOFO, and has the legal authority to apply and to receive the award.15

Infrastructure – The basic operational costs needed to manage the NPR program.

Maldistribution – Shortages of health care providers in some locations, such as rural and underserved areas, with other locations having a sufficient or an excess number of health care providers.

Meaningful Use of Technology – Meaningful Use is defined by the use of certified Electronic Health Record (HER) technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and that in using certified EHR technology the provider must submit to the Secretary of Health & Human Services (HHS) information on quality of care and other measures. Examples include, but are not limited to, telehealth, health informatics, and/or others that are in compliance with Health Information Portability and Accountability Act.

Residency – A training program that provides an individual or group of individuals (known as "residents") with post-graduate advanced clinical training.

Resident – A licensed NP who is enrolled with a government or private payer so that direct billing is possible for their own patient visits.

Sustainability – The ability to be sustained, supported, upheld, or confirmed. Projects under this Program will demonstrate sustainability by continuing their 12-month NPR Program without federal funding support.

14 Wood D. Effects of educational focus on a graduate nurse's initial choice of practice area. J Prof Nurs.

1998 Jul-Aug;14(4):214-9.

15 2 CFR 25.200.

https://bhw.hrsa.gov/grants/resourcecenter/glossary

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Telehealth – 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

Underserved – Refers to a population not receiving adequate health care, for example, due to inability to pay or barriers to health care access.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $20,000,000 to be available annually to fund approximately 20 recipients. HRSA anticipates funding a maximum of 8 recipients under Track 1 and a maximum of 20 recipients under Track 2.

Track 1 - Development and Start-Up applicants

Year 1: applicants may apply for a ceiling amount up to $500,000 total cost (includes both direct and indirect).

Years 2 – 4: applicants may apply for a ceiling amount of up to $100,000 total cost per year for each NP resident support. You are expected to train no less than four NP residents each year in years 2, 3 and 4.

Track 2 - Enhancement and/or Expansion applicants may apply for a ceiling amount of up to $100,000 total cost per year for each NP resident supported, not to exceed $1,000,000 total cost (includes both direct and indirect, costs) per year. You are expected to train no less than four NP residents each year of the project.

The period of performance is July 1, 2019 through June 30, 2023 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for ANE-NPR in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

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

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants are schools of nursing, nurse managed health clinics/centers, academic health centers, state or local governments and other private or public nonprofit entities determined appropriate by the Secretary.

Consortiums may apply for these funds, if otherwise eligible. HRSA’s will make one award per consortium to a lead entity for the consortium provided it is an eligible entity and has the legal authority to apply for and to receive the award on behalf of the other consortium members.

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

In addition to the 50 states, only eligible applicants in 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.

Individuals and for-profit entities are not eligible applicants under this NOFO.

Eligible NP Resident Participants To be eligible for the ANE-NPR Program the NP must meet all of the following:

o Be a licensed RN within 18 months of graduate school completion from a Primary Care NP Program (see list outlined in the Executive Summary) and NP certification;

o Be a citizen of the United States, a non-citizen national, or a foreign national who possesses a visa permitting permanent residence in the United States (i.e., individuals on temporary or student visas are not eligible to receive ANE-NPR Program support); and o Agree to be a full-time participant in the ANE-NPR Program.

Appointment of NP Residents and Length of Support16 o NPs in primary care who agree to commit to a full time residency program in a community-based entity qualify for an appointment as an ANE NP resident.

o An NP resident may be appointed at the beginning of any residency period, including a summer session, which falls within the budget period. All NP residents must be full-time in the residency program. Financial support is limited to 12 months for any one NP resident. A Statement of Appointment form that is compliant with the provisions of this NOFO (and all applicable programmatic and grant requirements) must be signed by the Project Director and NP resident, and must be maintained by the recipient institution for a period of at least three years after submission of the final expenditure

16Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. See pages 103 & 114. Retrieved from

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report, primarily for auditing and data collection purposes.

o NP residents must agree to provide the recipient institution with the following:

o The necessary information to complete the required Statement of

Appointment form. The NP resident should receive a copy of the completed form. As an example, the Statement of Appointment form may be accessed via the following link:

http://grants.nih.gov/training/phs2271.pdf. NOTE: The form should not be submitted to HRSA, but must be kept by the award recipient for formal record keeping for at least three years;

o Data regarding professional activity following completion of the ANE- NPR Program; and o A National Provider Identifier (NPI) number.

o Note that an entity may not transfer the NP resident unless HRSA approves the transfer, which will be done only in exceptional circumstances to another entity receiving funds under this award.

Termination of Nurse Practitioner Residents The recipient institution is responsible for monitoring the success of each NP resident.

Termination of an NP resident from being a recipient of the ANE-NPR Program funds applies if the NP resident:

o is unable to complete the residency program supported by the ANE-NPR award;

o withdraws from the recipient institution prior to the scheduled completion of the

ANE-NPR Program;

o fails to meet the predetermined academic standards of the recipient institution; or o requests to terminate the ANE-NPR Program support.

The ANE-NPR Program awardee should have standard operating procedures in place for the recruitment, training, retention, rescheduling, and termination of participants for the ANE-NPR Program. If a portion of the ANE-NPR Program training needs to be repeated, scheduling this activity to occur immediately following the conclusion of the award recipient cohort’s ANE-NPR Program is strongly encouraged and guidelines on this process should be incorporated into the standard operating procedures. Guidelines on how to recoup costs obligated in the case of termination of participants should also be included in the standard operating procedures.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $500,000 for budget year one of the Track 1- Development and Start-Up applicants and $1,000,000 annually for all other applicants as non-responsive and will not consider it for funding under this notice.

http://grants.nih.gov/training/phs2271.pdf

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Accreditation HRSA will consider any application that fails to include the required accreditation documentation in Attachment 1 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 803(b) of the Public Health Service Act.

Complete the MOE information and submit as Attachment 5.

Multiple Applications Multiple applications from an organization are not allowable. Eligible applicants can submit only one application per organization, campus, clinical facility, or consortium;

multiple applications from a single organization, campus, clinical facility, or consortium are not allowable. A campus is defined as a division of a university that has its own grounds, buildings (e.g., school of nursing) and faculty. A clinical facility is defined as a healthcare facility, whether part of a system or not, which has its own grounds containing its own leadership (chief nursing officer, chief medical officer, chief executive officer, etc.). Independent 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 tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

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” https://www.grants.gov/ https://www.grants.gov/applicants/apply-for-grants.html

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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.

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 11: Other Relevant Documents.

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

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

Program-Specific Instructions

Program Requirements

Applicants must provide advanced practice registered nurses (APRN) with support for training and practice that leads to master’s and/or doctoral degrees, or advanced practice competence while preparing nurses to serve as NPs in primary care in community-based settings. The ANE-NPR project must consist of a partnership between a community-based entity and an advanced nursing education academic entity to provide curriculum, didactic training, clinical coordination, and oversight of NP resident training, preceptor development, faculty practice, and partnership liaison.

Specifically indicate in your Project Abstract the track you are applying for when you submit your application.

Program Requirements for Track 1 - Development and Start-Up

a. Applicants must develop and implement a primary care ANE-NPR Program that supports postgraduate training programs for new NPs who are licensed and credentialed with professional liability insurance coverage.

b. This ANE-NPR Program must begin actively training participants no later than July 1, 2020 (year two of the ANE-NPR project start date). HRSA may reduce funding levels, or withhold future funding beyond the first year, if the program is unable to fully succeed in achieving this requirement.

Program Requirements for Track 2 - Enhancement and/or Expansion

a. Applicants must intend to enhance and expand their existing NP residency program in community-based primary care settings, and must currently implement an ANE-NPR Program in primary care that supports postgraduate training programs for new NPs who are licensed and credentialed with professional insurance coverage.

b. This ANE-NPR Program must begin actively training participants no later than October 31, 2019 (the second quarter of the ANE-NPR project start date). HRSA may reduce funding levels, or withhold future funding beyond the first year, if you are unable to fully succeed in achieving this requirement.

Program Requirements for All Applicants

Applicants must demonstrate to HRSA that their ANE-NPR Program will be able to carry out the following activities:

1. Conduct a Primary Care NP-Residency Program:

a. The program must establish linkages, as required by PHS Act section 802(d), with relevant educational and health care entities for the project. For

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this program, applicants must have in place or establish an academic clinical partnership to develop and implement the ANE-NPR Program in a primary care community-based setting. (See requirement 5 for more information)

b. This partnership must include an ongoing feedback mechanism with rapid cycle quality improvement (RCQI) for continual process improvement. This process should include establishing an academic clinical partnership Advisory Council and a schedule of reoccurring meetings (e.g., at least quarterly) as part of a multifaceted feedback loop for RCQI, to generally include, but not limited to the following: Health Education Specialist (HES), Health Education Coordinator (HEC), Health Information Technology Coordinator (HITC), evaluation coordinator, and academic dean (or equivalent), consultants and faculty, as well as any other relevant participants.

c. The program must provide NP resident support in the form of salaries to full-time residents who are licensed and certified NPs receiving at least 12 continual months of immersive clinical and didactic training at a primary care community-based entity. Please note: Grant fund support for NP resident must not exceed 70% of geographical market rate for a comparable NP Primary Care specialty salary.

2. Recruit Participants:

a. Applicants must document the utilization of standardized (See resource

National NPR and Fellowship Training https://www.nppostgradtraining.com/ for available standardized guidelines) outreach, recruitment and retention plans to engage state licensed and certified NPs in the specialty areas of primary care focus (as outlined in the Executive Summary) at the time of starting the program; and who begin the program no later than 18 months after receiving their graduate degree and NP certification.

b. Applicants must document a targeted pool of NPs by geographic area (region, state, county or local area), and how they will recruit NPs from this pool who have demonstrated a desire to practice in community-based settings, particularly in rural and/or underserved settings, upon program completion.

3. Train Participants:

a. Applicants must provide interprofessional team-based, clinical, and didactic training experiences along the practice continuum in primary care community-based settings. This Interdisciplinary team-based clinical practice training model must incorporate clinical rotations from both routine to specialty clinics. Primary care delivery through team-based care models has been demonstrated to lead to greater provider satisfaction, increased access to care and improved outcomes.17

b. These awards include a preference for projects that benefit rural or underserved populations. The most competitive applicant training programs

17 Bodenheim, T., Gboro, A., Willard-Grace & R. Grumbach. (2014). The Ten building blocks of high-performing primary care. Annals of Family Medicine, 12(2), 166-171.

https://www.nppostgradtraining.com/

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should include preceptor development and NP primary care competencies with a rural or underserved population-specific curriculum, such as those focused on HRSA priority topics including mental health, and/or substance use disorders, and value-based care delivery and quality improvement initiatives, childhood obesity, and maternal mortality. These are vulnerable populations who have major identified healthcare needs.

c. The training programs are encouraged to incorporate telehealth and meaningful use of technology (i.e., health informatics, and/or others that are in compliance with Health Insurance Portability and Accountability Act).

4. Create Linkages:

a. Each academic clinical partnership must have a signed Memorandum of

Understanding (MOU), which outlines specific aspects of the partnership:

name of partnership lead organization (primary applicant), name and address of partner(s) and timeframe of agreement. The MOU must also document the mutual benefit of the academic practice partnership, telehealth collaboration, agreement to participate in RCQI meetings and carry out related activities, and strategize for sustainability, curriculum development, and other types of support to be provided by members of the partnership (placement of NP graduates, curriculum development, etc.) (See Section iv Attachment 3 - Budget Justification).

b. Consortiums (as applicable) must have a binding relationship and signed agreement (Attachment 8) between/among the community-based entity members and the academic partner, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

c. If the applicant determines the need, funds may be used to secure technical assistance for ANE-NPR Program expert consultation.

Helpful resources for technical assistance ANE-NPR Program consultation are listed below:

American Nurses Credentialing Corporation Practice Transition Accreditation Program https://www.nursingworld.org/organizational-programs/accreditation/ptap/

National NPR and Fellowship Training

5. Employment Assistance Post Residency – Applicants must explain how they plan to implement employment assistance strategies to connect residency program participants to primary care employment, especially in rural and/or underserved areas.

a. Recruit, train, develop, support, and evaluate preceptors as program collaborators to enhance NP resident, preceptor, and clinical staff professional development.

b. Connect program graduates with the HRSA Health Workforce Connector (https://connector.hrsa.gov/connector/) and other existing employment support resources so they can obtain primary care employment with rural https://www.nursingworld.org/organizational-%20programs/accreditation/ptap/ https://www.nursingworld.org/organizational-%20programs/accreditation/ptap/ https://connector.hrsa.gov/connector/

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and/or underserved populations, preferably community-based clinical settings.

6. Participate in Cohort Collaboration - To provide support and ensure project success, collaborate (face-to-face and/or virtually) at a minimum of at least quarterly in the first project year and at least twice annually during the period of performance with other ANE-NPR Program award recipients and participate in HRSA-driven program evaluations during and upon completion of the period of performance.

7. Designate Project Staff - Applicants must identify appropriate personnel to carry out the ANE-NPR project. HRSA believes an effective ANE-NPR Program may generally include, but are not limited to many of the following personnel (or similar roles).

a. Health Education Specialist (HES) who collaborates with the academic-clinical team to assess the community-based entity’s capacity for the NPR program and infrastructure prior to the development of the ANE-NPR Program; curriculum development including population-based topics;

provides professional development activities of preceptors and other clinical staff based upon needs assessments.

b. Health Education Coordinator (HEC) who is the point of contact for day-to-day operations, and the educational liaison with clinical administration, preceptors, residents and academe; collaborates with HES and HITC on curriculum development; and conducts monthly meetings with each resident.

c. Health Information Technology Coordinator (HITC) who has experience in telehealth, health informatics, and Health Information Portability and Accountability Act compliance and that assures successful health information technology models are incorporated in the community health center clinical activities to which the new NPRs have been accustomed from previous academic practice training experiences;

supports and facilitates telehealth initiatives.

d. Evaluation Coordinator who uses best practice instruments to capture meaningful and key data (i.e., the results of the program, typically describing changes in people or systems), and reports findings to Advisory Council.

e. Clinical Liaison Lead (CLL) from the community-based entity that serves as the counterpart to academic dean and facilitates information exchange between the primary care NPR Program and the academic advanced nursing education partner; ensures preceptors function as program partners.

Residency Location All clinical training in the residency programs will be expected to take place in community-based settings, with a preference for those that provide primary care for rural and underserved populations. Community-based entities are strongly encouraged to provide employment opportunity assistance for NP residents upon completion of the ANE-NPR Program.

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Most competitive applicants build a pipeline of preceptors for the ANE-NPR Program using nursing staff at primary care delivery sites in rural and underserved areas such as Community Health Centers and Rural Health Clinics. Additionally, current or former HRSA scholars that have been trained or have demonstrated a commitment to work with rural or underserved populations should be considered. 18 The following are links to some HRSA programs that may be resources for building a primary care NP resident pipeline:

Nurse Corps Scholarship Program:

https://bhw.hrsa.gov/loansscholarships/nursecorps/scholarship

National Health Service Corps Scholarship Program https://www.nhsc.hrsa.gov/scholarships/index.html

Native Hawaiian Health Scholarship Program http://www.nhhsp.org/

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.

The Abstract must include:

1. A brief overview of the project as a whole

2. Specific, measurable objectives that the project will accomplish

3. Which of the HHS and HRSA clinical priorities will be addressed by the project, if 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. The track for which you are applying:

a. Track 1 - Development and Start-Up or

b. Track 2 - Enhancement and/or Expansion

6. A summary of the proposed projects and the number of NPs in primary care that will be trained to work in community-based settings, and

18 NURSE Corps or NHSC Scholars could be beneficiaries of the ANE-NPR program, in that they would defer their service obligation in order to receive further training through the ANE-NPR program. Once the one year post graduation training has been completed, they would complete their service obligation in a designated facility. NURSE Corps and NHSC loan repayment participants that are currently fulfilling service obligations could serve as preceptors for the ANE-NPR Program. Since participants are already employed at the site, they are on the site’s payroll (i.e. such as at a community health center) and would be treated the same as any non-HRSA participant.

NURSE Corps and NHSC loan repayment alumni could also serve as preceptors for the ANE-NPR program. Since they would have already completed their service obligations, they would have first-hand experience working with rural or underserved populations—thus a benefit to the site and to the community being served.

https://bhw.hrsa.gov/loansscholarships/nursecorps/scholarship https://www.nhsc.hrsa.gov/scholarships/index.html http://www.nhhsp.org/ http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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if applicable, with persons in rural, and/or medically-underserved communities.

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

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, consistent with forms and attachments, 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. Outline the needs of the community and the proposed training program. The applicant must describe and document: 1) the need for the NP training by discipline; 2) the training plan and 3) the employment placement plan post residency program. The applicant should include a discussion of the target population to be served by this segment of the health workforce, as well as the socio-cultural determinants of health and health disparities impacting the population or communities. Use and cite demographic data whenever possible to support the information provided.

Applicants must:

Discuss why, in both qualitative and quantitative terms, the applicant institution or organization needs these funds, and how the proposed project activities will strengthen the applicant’s ability to increase the distribution and readiness of primary care NPs in community- based settings.

Describe the community that will benefit from the improved distribution, and readiness to practice primary care NPs to include the following: the demographics of the population, the health status of the community, health literacy, social determinants of health, rural and/or underserved status, and other elements in support of your proposal.

Describe the need for primary care NPR Programs in the benefiting community, including a description of the catchment area where the proposed NP residents will be employed following completion of the ANE- NPR Program (Attachment 9).

Discuss any relevant barriers or measurable gaps for this population.

Document how the project addresses telehealth and other health care technology training models, and related HHS and HRSA priorities (See Purpose section).

Describe your organization’s current staffing to include the number and discipline of primary care preceptors.

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Include the proposed number for each of the four project years of NPs in primary care who have been targeted to participate in the ANE-NPR Program as residents, the demographics of those NPs and data describing where those participants are currently employed and/or the school of nursing from which they recently graduated. See Section iv. Budget Justification Narrative (NPR Support Costs – Sample Disbursement Plan).

Describe the number of NPs in primary care who have been targeted to participate as preceptors in the NPR Program, or who have at least two years of experience, the demographics of those NPs and data describing where those potential preceptors are currently employed, if not with the applicant organization.

Discuss the applicant organization’s willingness to, or past performance in, collaborating with a group of fellow HHS grant recipients.

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 describes in detail how you will implement a project of the proposed scope (a sample work plan can be found here: http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.).

Track 1 - Development and Start-Up applicants must:

Succinctly describe their current status, within the work plan, for development and/or start-up an NPR Program in primary care within the first year of award; with active participants in the program no later than July 1, 2020.

Include descriptions of current resources and partners, and/or plans to acquire and put in place all the necessary requirements during the startup time frame.

Clearly describe goals and timelines in the work plan that will assure an active program with NP resident participants in up to one year.

Clearly describe in detail all roles and responsibilities, to include who is responsible for each component of the startup.

All applicants must:

Provide a detailed description of the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance summarized in a table format with numbered…