PKG00247361-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Nurse Education, Practice, Quality and Retention (NEPQR) – Veteran Nurses in Primary Care (VNPC) Training Program

Funding Opportunity Number: HRSA-19-092

Funding Opportunity Type: Initial New

Catalog of Federal Domestic Assistance (CFDA) Number 93.359

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: March 8, 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: January 07, 2019

Marian Smithey, MSHP, RN Nurse Consultant, Project Officer Division of Nursing and Public Health Bureau of Health Workforce Telephone: (301) 443-3831 Email: MSmithey@hrsa.gov

Authority: Public Health Service Act, Sections 831 and 831A (42 U.S.C. 296p and 42 U.S.C. 296p-1)

HRSA-19-092

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019 Nursing Education, Practice, Quality and Retention (NEPQR) – Veteran Nurses in Primary Care (VNPC) Training Program. The purpose of this program is to recruit and train military veteran nursing students to practice at the full scope of their license in community-based primary care teams. In addition, the VNPC Training Program will provide professional development opportunities and educational support for practicing Registered Nurses/preceptors aimed at developing primary care expertise and skillsets to provide high-quality care that addresses the unique needs of veterans.

Funding Opportunity Title: Nursing Education, Practice, Quality and

Retention (NEPQR) – Veteran Nurses in Primary Care (VNPC) Training Program

Funding Opportunity Number: HRSA-19-092 Due Date for Applications: March 8, 2019 Anticipated Total Annual Available FY19 Funding:

$4,500,000

Estimated Number and Type of Awards: Up to nine cooperative agreements Estimated Award Amount: Up to $500,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: No Period of Performance: July 1, 2019 through June 30, 2022

(3 years) Eligible Applicants: Eligible applicants include accredited schools of nursing, as defined by PHS Act section 801(2), health care facilities, or a partnership of such a school and facility.

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

HRSA-19-092

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

HRSA-19-092 iii

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

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 .. ERROR! BOOKMARK NOT DEFINED.

HRSA-19-092 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Nursing Education, Practice, Quality and Retention (NEPQR)-Veteran Nurses in Primary Care (VNPC) Training Program.

Program Purpose In FY 2018, HRSA implemented the Nurse Education, Practice, Quality and Retention (NEPQR)-Registered Nurses in Primary Care (RNPC) Program to recruit and train nursing students and current registered nurses (RNs) to practice to the full scope of their license in community-based primary care teams. This program aims to increase access to care, with an emphasis on chronic disease prevention and control, including mental health and substance use disorders. The NEPQR- VNPC Training Program is an expansion of the NEPQR-RNPC investment specifically targeting undergraduate nursing students who are veterans and current primary care RNs.

The NEPQR-VNPC Training Program objectives are to:

1) recruit primary care-oriented veteran undergraduate nursing students committed to practicing in non-institutional settings to provide primary health care in medically underserved communities;

2) provide longitudinal clinical training experiences for veteran undergraduate nursing students in community-based primary care;

3) offer continuing professional development in primary care for practicing RNs, clinical preceptors, and faculty aimed at developing primary care expertise and skillsets to provide high-quality care that addresses the unique needs of veterans with an emphasis on chronic disease prevention and control, including mental health and substance use disorders;

4) enhance didactic and clinical training curricula to integrate primary care, population health, and interprofessional education (IPE) with an emphasis on chronic disease prevention and control, including mental health and substance use disorders;

5) facilitate partnerships between veteran, academia, and clinical partners via a partnership liaison; and

6) address physical, emotional, and environmental issues that may be unique to veterans that could potentially impact learning, negatively interfere with program completion, and deter gainful employment in nursing after graduation.

Like the NEPQR-RNPC Program, the NEPQR-VNPC Training Program aims to achieve a sustainable primary care nursing workforce equipped with the competencies necessary to deliver value-based primary care, improve the distribution of the nursing workforce, increase access to care, and improve population health outcomes by strengthening the capacity for basic nurse education and practice.

https://bhw.hrsa.gov/fundingopportunities/?id=f5ad18f6-eafc-4c72-baf1-5ad606a354c3 https://bhw.hrsa.gov/fundingopportunities/?id=f5ad18f6-eafc-4c72-baf1-5ad606a354c3

HRSA-19-092 2

2. Background

The NEPQR Training Program is authorized by Sections 831 and 831A of the Public Health Service Act (42 U.S.C. § 296p and 296p-1) to strengthen the capacity for basic nurse education and practice. The NEPQR-VNPC Training Program addresses all three priority areas (education, practice, and retention) as defined in the statute.

The delivery of high-value primary care is essential to improving the health of all Americans. The primary care workforce is responsible for the provision of primary and preventive care to a population that is increasingly demanding these services, due largely to the aging of the population and the growing number of individuals with complex medical needs. The percentage of the population 65 years or older will grow to

21.7 percent by 2040.1 Approximately half of all Americans have at least one chronic disease, and 25 percent have multiple chronic conditions.2 The prevalence of multiple chronic conditions increases significantly with age and impact 75 percent of older adults. These rates are expected to rise with the obesity epidemic and are compounded by the increased behavioral health needs that have resulted from unmet mental health needs and the opioid epidemic.3 Currently, chronic diseases account for 75 percent of primary care visits. Increased emphasis on population health, quality of care, and the value of the services delivered has resulted in a need to shift health care from acute care to community-based settings.4 However, the current organization and scope of the primary care system are insufficient in meeting the needs of the nation.5

As health care providers and policy makers continue to focus on improving quality and health outcomes at lower cost, identification of the key features and strategies that define primary care excellence are fundamental in the restructure. The Centers for Medicare and Medicaid Services (CMS) identified tenets of transformed health care delivery systems that emphasize integrated care models; comprehensive care coordination; care teams performing at the top of their licenses and board certification;

patient engagement; data driven quality improvement, and population health management.6 As the nation’s health care culture continues to shift toward an integrated, comprehensive approach to health, strengthening the core of primary care is critical to the delivery of better, safer, higher quality care. As a result, innovative

1 Echevarria, M., Salmond, S. (2017). Healthcare Transformation and Changing Roles for Nursing.

Orthopedic Nursing, 36(1), 12-25.

2 Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF - 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.

3 Galea, Sandro (2018) Guns, Obesity, and Opioids: A Population Health Science Perspective on 3 Contemporary Epidemics. Retrieved from https://www.milbank.org/quarterly/articles/guns-obesity-and-opioids-a-population-health-science-perspective-on-3-contemporary-epidemics/.

4 Fraher, Erin (2015). University of Pennsylvania Leonard Davis Institute of Health Economics Interdisciplinary Nursing Quality Research Initiative: Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules. Retrieved at http://www.shepscenter.unc.edu/wp-content/uploads/2015/07/inqri-ldi-brief-nursing.original.pdf.

5 IOM (Institute of Medicine). (2012). Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC: The National Academies Press. Retrieved from https://www.nap.edu/read/13381/chapter/1#ii.

6 Centers for Medicare & Medicaid Services. (2014). Innovation State Innovation Models Program.

Retrieved from innovation.cms.gov/initiatives/State-Innovations/.

http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf https://www.milbank.org/quarterly/articles/guns-obesity-and-opioids-a-population-health-science-perspective-on-3-contemporary-epidemics/ https://www.milbank.org/quarterly/articles/guns-obesity-and-opioids-a-population-health-science-perspective-on-3-contemporary-epidemics/ http://www.shepscenter.unc.edu/wp-content/uploads/2015/07/inqri-ldi-brief-nursing.original.pdf http://www.shepscenter.unc.edu/wp-content/uploads/2015/07/inqri-ldi-brief-nursing.original.pdf https://www.nap.edu/read/13381/chapter/1#ii http://innovation.cms.gov/initiatives/State-Innovations/

HRSA-19-092 3

primary care delivery and workforce models have emerged to expand access, improve care, advance health, and increase value.

Evolving models of care underscore the importance of team-based care, leading organizations to redefine traditional roles and responsibilities of team members as a more effective means to meet patient needs. RNs are the largest health care workforce in the United States at 2.8 million, but are not consistently utilized in the primary care healthcare model.7 In redesigned health care systems, nurses are assuming enhanced roles for a broad range of patients in community-based primary care. These changes will require an expanded skill set focused on wellness and population care, with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.8 Core competencies for primary and preventive care practice have been defined by the Quad Council of Public Health Nursing Organizations and the American Academy of Ambulatory Care Nursing.9 These skill sets align with and support effective nursing practice in transforming healthcare delivery systems. As new roles diffuse through the health care system, nurse educators and current RNs need to focus on building skills to practice as part of interprofessional care teams with shared responsibility and accountability for the health of populations in an increasing value-focused care environment.

The emerging and enhanced roles for RNs requires a redesign of nursing education and clinical training systems to support nursing practice in a transformed heath care system.

Current nursing education and clinical training models overwhelmingly focus on acute care and lack sufficient primary care content. To keep pace with the rapidly changing healthcare environment, nurse educators must continuously evaluate and revise education curricula, approaches, and programs used to educate new and practicing nurses. Likewise, to prepare nurses to practice in new models of care, clinical rotations need to include exposure to high-performing teams in community-based settings, and provide longitudinal experiences with patients and family caregivers. Academic-practice partnerships are a critical mechanism to help ensure the transformative changes in front-line care delivery systems are incorporated into curricula and clinical training requirements for nurses. Effective partnerships create systems where students have relevant curricula, quality clinical training sites, well-trained faculty and preceptors, and produce graduates with the experience and competencies that facilitate employment in community-based primary care.

There is a compelling need to recruit and retain RNs in primary health care to address the rapidly expanding primary health care access crisis, improve the health of our nation, and promote the creation of healthy and satisfying work environments for RNs and interprofessional team members. Veterans bring a unique skill set, valuable work

7 Josiah Macy Jr. Foundation. (2016). Registered Nurses: Partners in Transforming Primary Care.

Retrieved from http://macyfoundation.org/publications/publication/conference-summary-registered-nurses-partners-in-transforming-primary-care.

8 Echevarria, M., Salmond, S. (2017). Healthcare Transformation and Changing Roles for Nursing.

Orthopedic Nursing, 36(1), 12-25 9 Quad Council Coalition Competency Review Task Force. (2018). Community/Public Health Nursing Competencies.

http://macyfoundation.org/publications/publication/conference-summary-registered-nurses-partners-in-transforming-primary-care http://macyfoundation.org/publications/publication/conference-summary-registered-nurses-partners-in-transforming-primary-care

HRSA-19-092 4

experience, and a demonstrated commitment to public service. Military experience instills the value of leadership, teamwork, discipline, reliability, and detail-orientation easily transferred into civilian nursing careers. In addition, almost a quarter of all veterans in the United States, 4.7 million, return from active military careers to reside in rural communities.10 According to the National Association of Community Health Centers, veterans tend to view jobs as careers and have higher retention rates (50 percent or more) than the healthcare industry standard.11 For these reasons, veterans are ideal candidates for addressing the primary care nursing workforce needs.

Despite their value add, veterans face several barriers to attaining a healthcare career including academic, cultural, social, wellness, and physical challenges. To address these barriers, veterans benefit greatly from evidence-based strategies tailored to address the identified social determinants and needs that impede their education and support success including, tutors, mentors, advisors with military backgrounds, and support services such as training in time-management, test-taking skills, career counseling, and job search assistance, to name a few. In addition, as the number of veterans receiving care from civilian providers increases, it is critical for the health workforce to have the capacity to address the service-connected health-related needs of veterans. HRSA has learned from its Veterans Bachelor of Science Degree in Nursing programs that when schools of nursing address these needs and connect veterans with timely support services, veterans can thrive.12

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs is located at the Health Workforce Glossary. In addition, the following definitions apply to the NEPQR-VNPC Training Program for Fiscal Year 2019:

Enhanced RN role is the utilization of RNs in primary care to the fullest extent of their education and practice. This enhanced RN role spans functional areas such as episodic and preventive care, triage, documentation of health status, chronic disease management, hospital transition management, delegated care for illness, health coaching, supervision of other staff, and quality improvement leadership. 13,14

Longitudinal experiential training is the process of instruction between a designated faculty and/or nursing preceptor and an individual(s) that includes a component of direct

10 U.S. Department of Veteran Affairs, Office of Rural Health: Rural Veteran Health Care Challenges.

Retrieved from https://www.ruralhealth.va.gov/aboutus/ruralvets.asp.

11 Ibid.

12 Rossiter, A.G., Morrison-Beedy, D., Capper, T., D’Aoust, R., Voelpel, P. E., Escallier, L., Fullerton, J., Rodriguez, I. (2017). Meeting the needs of the 21st century veteran: Development of an evidence-based online veteran healthcare course. Journal of Professional Nursing, 34(4), 280-283. Jul-Aug 2018.

https://doi.org/10.1016/j.profnurs.2017.10.007 13 Flinter, M., Blankson, M., & Ladden, M. (2016). Registered Nurses in Primary Care: Strategies that Support Practice at the Full Scope of the Registered Nurse License. Commissioned Paper for the 2016 Macy Foundation Conference.

14 Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the Registered Nurse in Primary Health Care: Meeting Health Care Needs in the 21st century. Nursing Outlook, 63(2), 130-136. Retrieved from http://dx.doi.org/10.1016/j.outlook.2014.08.004 https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.ruralhealth.va.gov/aboutus/ruralvets.asp https://doi.org/10.1016/j.profnurs.2017.10.007

HRSA-19-092 5

work experience over a period of time to adequately immerse the individual(s) in that training, and providing education in new technologies, including distance learning methodologies like telehealth technology where appropriate (at least 150 hours).

Non-institutional settings are community-based primary care sites including but not limited to: Federally Qualified Health Centers (FQHCs), Nurse-Managed Health Clinics, Rural Health Clinics, state or local health departments, Department of Veterans Affairs medical facilities, Area Health Education Centers, AIDS Education and Training Centers, and Public Health Training Centers.

Population health is an approach to health focused on the health outcomes of a group of individuals, including the distribution of such outcomes within the group.15 It involves applying health strategies, interventions, and policies at the population level rather than through the episodic, individual-level actions common within acute care.16

Registered Nurse is a nurse who has graduated from a school of nursing, passed the National Council Licensing Registered Nurse examination, and is licensed to practice as a registered nurse in a state.

Registered Nurse student is a student currently enrolled in an accredited undergraduate nursing program.

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

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

II. Award Information

1. Type of Application and Award

Types of applications sought: New

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

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

15 Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93, 380-383.

16 National Advisory Council on Nurse Education and Practice – HRSA (2016). Preparing Nurses for New Roles in Population Health Management: 14th Annual Report to the Secretary of the United States, Department of Health and Human Services and the Congress of the United States. Retrieved from https://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/fourteenthreport.pdf https://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/fourteenthreport.pdf

HRSA-19-092 6

1. Provide ongoing input in all phases of the project to accomplish the goals;

2. Participate, as appropriate, in meetings or site visits;

3. Review and approve project information prior to dissemination;

4. Provide direction, assistance and referral in the establishment and facilitation of effective collaborative relationships with federal and state agencies, HRSA grant projects, and other resource centers and entities relevant to the project’s objectives;

a. Specifically, HRSA will share the list of NEPQR-VNPC award recipients with the FORHP-Rural veterans Program, which provides funding to States to work with providers and other partners to improve access to needed health care services and improve the coordination of care for veterans living in rural areas.

5. Provide guidance concerning the content, structure and format of required reports;

6. Support and direct the dissemination of effective clinical and/or community practice models that emerge from the NEPQR-VNPC; and

7. Review training programs, and identify opportunities to expand best practice models to populations that reflect the populations served.

The cooperative agreement recipient’s responsibilities will include:

1. Develop, implement, and evaluate projects to ensure that they meet the objectives outlined in Section I of this NOFO;

2. Engage, collaborate, and communicate with HRSA staff for input on project activities, quality improvement, and dissemination of lessons learned and effective practice models;

3. Participate in HRSA-provided training and technical assistance as appropriate;

4. Engage with relevant stakeholders to ensure project success and sustainability;

5. Engage, collaborate, and communicate with other NEPQR-VNPC awardees in a learning community to share practice innovations and leverage resources; and

6. Adhere to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the R&R Application Guide (Acknowledgement of Federal Funding).

2. Summary of Funding

HRSA expects approximately $4,500,000 to be available annually to fund approximately nine recipients. You may apply for a ceiling amount of up to $500,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is July 1, 2019 through June 30, 2022 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for the NEPQR-VNPC Training Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

https://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-19-092 7

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

In accordance with Sections 831(g) and 831A(f) of PHS Act, eligible applicants include accredited schools of nursing as defined by section 801(2), health care facilities, or a partnership of such a school and facility.

Schools of nursing affiliated with the proposed project must be an accredited public or private school. Applicants must provide documentation of current accreditation by a national nurse education accrediting agency or state approval agency recognized by the U.S. Department of Education for the purposes of nursing education as Attachment 1.

Individuals are not eligible to apply.

In addition to the 50 states, eligible entities 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. Tribes and Tribal organizations may apply for these funds, if otherwise eligible. Foreign entities are not eligible for this HRSA award.

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 ($500,000) 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

HRSA-19-092 8

receiving the award, as required by Sec. 803 (b) of the Public Health Service Act.

Complete the MOE information and submit as Attachment 8.

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

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

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

Eligible Students Eligible NEPQR-VNPC training program participants include undergraduate nursing students who were honorably or generally discharged service members (including reservists and National Guardsmen) from any Armed Services branch. Active duty service members will also be considered eligible contingent upon their ability to meet university admission requirements, military obligations (as applicable), and commanding officer permissions.

NEPQR-VNPC training program participants must be a citizen of the United States, a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national. Individuals on temporary or student visas are not eligible to receive NEPQR-VNPC support.

Eligible RNs RNs must hold valid license and be an employee of the accredited school of nursing as defined by section 801(2), health care facility, or partner of such a school and/or facility.

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

HRSA-19-092 9

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 70 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 10: Other Relevant Documents.

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

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

HRSA-19-092 10

Program-Specific Instructions

Program Requirements Applicants are required to establish or expand academic-practice partnerships to train veteran nursing students and support current RNs in non-institutional settings; such as community-based primary care, in accordance with the linkage/partnership requirement in Section 802(d) of the Public Health Service Act.

• If the applicant organization is an accredited school of nursing, they must partner with community-based primary care sites (e.g., Federally Qualified Health Centers, Nurse-Managed Health Clinics, and Rural Health Clinics).

• If the applicant organization is a health care facility, they must:

o provide primary care services in a community-based setting; and o partner with an accredited school of nursing.

HRSA also encourages partnerships with other non-institutional settings, including but not limited to state or local health departments, Veterans Affairs medical facilities, Area Health Education Centers, AIDS Education and Training Centers, and Public Health Training Centers.

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:

The partnerships are required to implement the following activities:

1. Implement a system for recruitment of primary care-oriented veteran undergraduate nursing students committed to practicing in non-institutional settings to provide access to primary health care in medically underserved communities;

2. Provide longitudinal clinical training experiences for veteran undergraduate nursing students in community-based primary care, with an emphasis on military culture, veteran student needs, chronic disease prevention and control, including mental health and substance use conditions, include telehealth technology where appropriate to accomplish all clinical training;

3. Deliver continuing professional development in primary care for practicing RNs, clinical preceptors, and faculty aimed at developing primary care expertise and skillsets to provide high-quality care that addresses the unique needs of veterans with an emphasis on chronic disease prevention and control, including mental health and substance use disorder, which is to include telehealth technology where appropriate;

4. Enhance didactic and clinical training curricula to integrate primary care, population health, and IPE with an emphasis on chronic disease prevention and control, including mental health and substance use disorder; ensure that curricular modifications comply with your local VA certifying official’s requirements in order to preserve GI benefit eligibility.

5. Identify a full time partnership liaison (1 FTE) paid from this grant as a formal facilitator between veteran, academia and clinical partners;

HRSA-19-092 11

6. Address physical, emotional, and environmental issues that may be unique to veterans that could potentially impact learning, negatively interfere with program completion, and deter gainful employment in nursing after graduation; and

7. Include mentorship and other supportive services (including outreach to veteran’s organizations) that address the unique challenges that veterans face when transitioning to civilian life.

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

The Abstract must include:

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

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

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

4. Funding preference, if applicable; and

5. The funding amount requested.

The project abstract must be single-spaced and is limited to one page in length.

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

You must describe the purpose and need for the proposed project, including:

• Community served, including demographics, health status, social determinants of health, unmet health care needs, and barriers to care;

• Current health care delivery system and primary care nursing workforce gaps, including recruitment and retention barriers;

• Targeted veteran student population and identified needs that necessitate support services;

• Structural changes necessary to create academic environments that are adaptive to veteran student needs and facilitate academic success;

• Barriers to clinical training in community-based primary care teams;

• Curricula modifications/enhancements needed;

• Gaps in primary care competencies and training needs of veteran RN students, faculty/preceptors; and

• Gaps in military cultural competencies and training needs of current RNs to provide high-quality care that addresses the unique needs of veterans.

HRSA-19-092 12

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

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

(a) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion #2 (a).

In this section, you must propose the methods that will be used to address the needs and meet the program requirements identified in the Purpose and Need section above.

Specifically, applicants must identify strategies and/or activities to address the student, community, and system needs, explain the rationale for proposing specific activities, and present a clear connection between identified system gaps, needs, and the proposed activities.

You must submit a logic model for designing and managing the project as Attachment 6. 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. For the purposes of this announcement, the logic model should summarize the connections between the:

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

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

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

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

• Activities (e.g., approach, key interventions);

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

• Outcomes (i.e., program results, change in people or systems).

Please refer to Section VIII Other information Logic Model Guidelines.

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

You must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope as Attachment 2. You must state objectives and sub-objectives that are specific, measurable, achievable, realistic, and time-framed and clearly explain how they will be implemented. A sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.

The work plan must include:

• Goals of the project (including objectives and sub-objectives);

• Responsible entity/entities (i.e., key staff and partners);

• Activities;

• Timeline;

• Deliverables and/or products; and

• Proposed outcomes including the number of current and future RNs who will be trained each project year.

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

HRSA-19-092 13

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (c) Discuss likely challenges and anticipated major barriers in the design and implementation of the activities described in the work plan and approaches that you will use to resolve such challenges. Describe how you monitor progress towards program objectives and strategies to address challenges or obstacles.

Challenges discussed should be specific to the proposed project and relate to either the overall goal(s) or objective(s) proposed within the work plan.

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 your plan for evaluating program performance. This plan must monitor ongoing processes and progress toward meeting program objectives and describe how the unique needs of target populations of the communities served are routinely assessed and improved. The evaluation plan must, at a minimum, assess the effectiveness of the award-funded activities and include a continuous quality improvement plan. The evaluation plan must 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 demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and

2) the extent to which these can be attributed to the project.

Additionally, you must describe your process to track trainees after program completion/graduation for two years, which may 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.

Programs must report on their findings in their annual Performance and Progress Reports. You must also describe the systems and processes used by your organization to collect required HRSA performance metrics for this program. This includes your capacity to track, validate, and report required data to allow for accurate and timely reporting of performance outcomes to HRSA. The following link includes examples of the required program performance measures for this program:

http://bhw.hrsa.gov/grants/reporting/index.html.

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

You must provide a clear sustainability plan for the project after the period of funding ends, including a description of specific actions to:

• Support all program requirements beyond the federal investment;

http://bhw.hrsa.gov/grants/reporting/index.html

HRSA-19-092 14

• Develop a business model that includes integration or enhancement of RNs into the community-based primary care delivery model;

• Leverage lessons learned from past program participants and apply to improve future training and partnership opportunities;

• Identify and disseminate key project results and best practices to appropriate audiences; and

• Forecast likely challenges in sustaining the program, and outline approaches 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, structure, scope, and relevant experience. You must discuss the roles, responsibilities, and functions of each member of the academic-practice partnership and describe how these elements contribute to your ability to execute the program requirements and meet program expectations. Describe the qualifications of the Partnership Liaison and their role(s) in the success and sustainability of the project. (A project organizational chart is requested in Section IV.2.v, Attachment 5.) Discuss how you will implement the project, properly account for the federal funds, and document all costs.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 3 (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 letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with populations that reflect the communities 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.

HRSA-19-092 15

• 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 Government public 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 three 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.

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) Methodology/Approach

(b) Work Plan

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Methodology/Approach

(b) Work Plan

(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.

HRSA-19-092 16

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.

The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L.