PKG00248127-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Nurse Anesthetist Traineeship (NAT) Program

Funding Opportunity Number: HRSA-19-074

Funding Opportunity Type: New, Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number: 93.124

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: April 15, 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: February 04, 2019

Karen Delia Breeden, MPA Michael McCalla, MHSA NAT Project Officers Telephone Numbers: (301) 443-5787 / 301-443-0856 Email Addresses: KBreeden@HRSA.gov / MMcCalla@HRSA.gov

Authority: Public Health Service Act, Section 811(a)(2) of the Public Health Service Act (42 U.S.C. 296j(a)(2)).

mailto:KBreeden@HRSA.gov mailto:MMcCalla@HRSA.gov

HRSA-19-074 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the Nurse Anesthetist Traineeship (NAT) Program. The purpose of this program is to support eligible entities to meet the cost of traineeships for individuals in nurse anesthesia degree programs. Grants are awarded to accredited institutions that educate registered nurses to become nurse anesthetists; recipient institutions, in turn, disburse funds to students in the form of traineeship support. The aim is to increase the number of Certified Registered Nurse Anesthetists nationally who are well-prepared and well-positioned to practice independently and deliver evidence-based, high-quality, and safe anesthesia and services related to management and treatment of acute and chronic pain. NAT students may use traineeship funds during the period for which the traineeship is provided for full or partial costs of the tuition and fees, books/e-books, and reasonable living expenses (stipends). The funds appropriated for the NAT Program are distributed among all eligible applicant institutions based on a formula.

Funding Opportunity Title: Nurse Anesthetist Traineeship Program

Funding Opportunity Number: HRSA-19-074

Due Date for Applications: April 15, 2019

Anticipated Total Annual Available

Funding:

$2,250,000

Estimated Number and Type of Award(s): Up to 80 grants

Estimated Award Amount: Award amount determined by formula.

Cost Sharing/Match Required: No

Period of Performance: July 1, 2019 – June 30, 2020 (1 year)

Eligible Applicants: Eligible applicants are schools of nursing, nursing centers, academic health centers, State or local governments, and other public or private nonprofit entities determined appropriate by the Secretary.

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.

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

HRSA-19-074 ii

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/ to learn more about the resources available for this funding opportunity.

https://bhw.hrsa.gov/fundingopportunities/

HRSA-19-074 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. NAT Program Specific Data Forms (NAT Table 1 and NAT Table 2)

vi. Attachments Dun and Bradstreet Universal Numbering System (DUNS) 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

APPENDIX

HRSA-19-074

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Nurse Anesthetist Traineeship (NAT) Program.

Program Purpose The purpose of the Nurse Anesthetist Traineeship Program is to increase the number of Certified Registered Nurse Anesthetists (CRNAs) providing care, especially to rural and underserved populations.

Program Goals To achieve this purpose in a timely and effective manner, the Nurse Anesthetist Traineeship Program provides support to full-time nurse anesthetist trainees, through educational institutions, to reduce the financial burden on students.

Program Objectives Accredited institutions that educate Registered CRNAs Nurses to become will disburse funds to Student Registered Nurse Anesthetists in the form of traineeship support. The funds for the NAT Program are distributed among all eligible applicant institutions based on a formula. Student Registered Nurse Anesthetists may use traineeship funds during the period for which the traineeship is provided for full or partial costs of the tuition and fees, any required books/e-books and reasonable living expenses (stipends).

Program Priorities Applicants are encouraged to select and address one of the Health Resources and Services Administration (HRSA) priorities below which include the Department of Health and Human Services’ (HHS) priorities of combatting the opioid crisis and transforming our healthcare system from one that pays for procedures and sickness to one that pays for outcomes and health through value-based care.

Combatting the opioid crisis*/Mental Health

Value-based care delivery and quality improvement initiatives

Transforming the workforce –targeting the need

Telehealth**

Childhood obesity

Maternal Mortality

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

https://www.hrsa.gov/opioids

**Telehealth can be an important tool for delivering services and resources to HRSA’s target populations. HRSA encourages applicants to include support for telehealth as a mechanism to meet programmatic goals in this Notice of Funding Opportunity, as appropriate. Refer to https://www.hrsa.gov/rural-health/telehealth/index.html for specific information and resources.

2. Background

The Nurse Anesthetist Traineeship (NAT) Program is authorized by Title VIII, Section 811(a)(2) of the Public Health Service Act, 42 U.S.C. § 296j(a)(2).

The NAT program aims to increase the number of Certified Registered Nurse Anesthetists (CRNAs) who are well-prepared and well-positioned to practice independently and collaboratively within interprofessional teams delivering evidence-based, high-quality, and safe anesthesia and pain management services. Anesthesia and pain management services encompass the continuum of anesthesia care for surgical procedures as well as the management and treatment of acute and chronic pain. CRNAs, like anesthesiologists, practice in a variety of settings providing anesthesia care and pain management services to an older and increasingly diversified population.

Role of CRNAs in addressing opioid abuse in rural areas

According to the National Center for Health Statistics, Centers for Disease Control and Prevention, in 2017 more than 70,200 Americans died from drug overdoses. Drug overdose deaths increased from 16,849 in 1999 to 70,237 in 2017. [1] Opioid prescribing rates in rural areas are significantly higher than those in urban areas. Drug overdose death rates in rural areas have also exceeded the drug overdose rates in urban areas. For example, the opioid death rates in rural areas, tripled for females and quadrupled among 18-25 year olds from 1999 to 2015.2

Through their holistic, interdisciplinary and multi-modal approach, CRNAs play an integral role in appropriate use of opioids for patients receiving anesthesia, sedation, and pain management services for acute and chronic pain. CRNAs are the primary providers of anesthesia care in rural America and, in some instances, may be the sole provider of anesthesia services. Because they are more likely to practice in rural areas where the opioid crisis is most acute, CRNAs are at the frontline of the opioid crisis. Furthermore, as people across multiple sectors (e.g., first responders, health professionals and law enforcement) work to address the opioid crisis in America, appropriate utilization of anesthesia and pain management services is of utmost importance.3

[1] Source: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

(2) García MC, Heilig CM, Lee SH, et al. Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties

Among Primary Care Providers Using an Electronic Health Record System — United States, 2014–2017. MMWR Morb

Mortal Wkly Rep 2019;68:25–30. DOI: http://dx.doi.org/10.15585/mmwr.mm6802a1

(3) Source: https://www.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/crna-fact-sheet.pdf?sfvrsn=c5f641b1_4 https://www.hrsa.gov/rural-health/telehealth/index.html https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates https://www.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/crna-fact-sheet.pdf?sfvrsn=c5f641b1_4 https://www.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/crna-fact-sheet.pdf?sfvrsn=c5f641b1_4

By providing didactic and clinical teaching/training for NAT students in opioid addiction management and treatment and options for non-opioid pain management and anesthesia, the NAT award recipients will be supporting HHS’s and HRSA’s priority to combat the opioid abuse epidemic, especially among rural and underserved populations.

Resources:

HHS

https://www.hhs.gov/opioids/about-the-epidemic/index.html

Health Resources and Services Administration https://www.hrsa.gov/opioids

Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/drugoverdose/index.html

CDC Guideline for Prescribing Opioids for Chronic Pain https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Substance Abuse and Mental Health Services Administration https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full- Document-Including-Executive-Summary-and-Parts-1-5-/SMA18-5063FULLDOC https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources

3. Program Definitions

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

New Funding Opportunity Type is an application that is being submitted to HRSA for the first time and has not previously received an NAT award.

Competing Continuation Funding Opportunity Type is an application or an award made for additional funding/budget period for a project with a projected completion date, through a competing process.

New Appointment means the appointment of a student to receive NAT funds during the current budget/project year who has not received NAT support during any previous budget period/period of performance.

Reappointment means any appointment of a student to receive NAT funds during the current budget/project year who has received NAT support during any previous budget period/period of performance.

https://www.hhs.gov/opioids/about-the-epidemic/index.html https://www.hrsa.gov/opioids https://www.cdc.gov/drugoverdose/index.html https://www.cdc.gov/drugoverdose/prescribing/guideline.html https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document-Including-Executive-Summary-and-Parts-1-5-/SMA18-5063FULLDOC https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document-Including-Executive-Summary-and-Parts-1-5-/SMA18-5063FULLDOC https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources https://bhw.hrsa.gov/grants/resourcecenter/glossary

II. Award Information

1. Type of Application and Award

Types of applications sought: New and Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $2,250,000 to be available in to fund approximately eighty

(80) recipients annually. Awards will be distributed among all eligible institutions based on a formula calculation using data supplied by applicants in the NAT Program Specific Data Forms (see appendix). Applicants that fail to submit this information will not be considered for funding. The period of performance is July 1, 2019 through June 30, 2020 (1 year).

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

III. Eligibility Information

1. Eligible Applicants

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

Foreign entities are not eligible for this HRSA award.

Individuals are not eligible to apply to this NAT Program NOFO. Individuals must consult directly with the academic institution (not HRSA) regarding this program.

Any school(s) of nursing affiliated with this application must be accredited to provide graduate nurse anesthesia education at the time of application – and for the duration of the award – by the Council on Accreditation of Nurse Anesthesia Educational Programs.

In addition to the 50 states, eligible applicants from 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.

Beneficiary (Student-Trainee) Eligibility Requirements To receive NAT traineeship support from a recipient institution, an individual must be

Enrolled full-time in an accredited course of study leading to a graduate degree in nurse anesthesia;

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

A citizen of the United States, a non-citizen national, or a foreign national having in his/her possession a visa permitting permanent residence in the United States;

Eligible to sit for the certification examination administered by the American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists to become a Certified Registered Nurse Anesthetist upon program completion; and

Able to provide the institution with the necessary information to complete the required Statement of Appointment Form https://grants.nih.gov/training/phs2271.pdf . Beneficiaries (Students-Trainees) must receive a copy of the form which is maintained at the entity for a period of at least three years primarily for accountability, program integrity, and auditing and data collection purposes. Please do not submit the form to HRSA.

NOTE: Individuals on temporary student visas are not eligible to receive NAT traineeship support.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Due Date HRSA will consider any application that fails to satisfy the due date requirements referenced Section IV.4 to be 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 document and submit as Attachment 1.

Multiple Applications Multiple applications from an organization are not allowable; however, applicants can submit one application per campus (must have unique DUNS numbers). A campus is defined as a division of a university that has the same name yet is separate with its own grounds, buildings (e.g., school of nursing) and faculty. For example, the University of Homestate at Smalltown and the University of Homestate at Anytown can each submit an application for this program. Multiple applications from an organization with the same DUNS number are allowable if the applications propose separate and distinct projects.

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.

https://grants.nih.gov/training/phs2271.pdf%20.

https://grants.nih.gov/training/phs2271.pdf%20.

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

NAT Program Specific Forms Applications received without the appropriate OMB-approved NAT Program Specific Data Forms (NAT Tables) will be deemed non-responsive to the NOFO and will not be considered for funding under this notice. All required NAT Program Specific Data Forms must be submitted electronically with the application in Grants.gov.

Length of Support

A trainee may be appointed at the beginning of any academic period, including a summer session, which falls within the budget period specified by the current Notice of Award (NoA).

Any new appointment (see program definitions in Section I.3) must be made for a period of not fewer than nine months and not to exceed a period of 12 months.

The only exception to the minimum appointment is to allow a student to complete the program.

Trainees may receive a reappointment (see program definitions in Section I.3).

The cumulative traineeship support may not exceed 36 months and must be continuous from the start of the initial appointment.

The traineeship is not transferable from the recipient institution that provided the support. An appointment may be provided by more than one institution if the student who has a traineeship at one institution receives an appointment in another institution, but only if the cumulative traineeship support received does not exceed 36 months.

Trainees must agree to provide the recipient institution with the necessary information to complete the required Statement of Appointment Form.

Termination of Trainees The recipient institution is responsible for monitoring the academic success of each trainee and shall ensure the termination of traineeship support under the NAT program in cases where the trainee:

Is unable to complete the program of study for which the traineeship was awarded;

Withdraws from the institution prior to the scheduled completion of the program;

Fails to meet the predetermined academic standards of the institution; or

Requests to terminate NAT Program support.

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.

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

If you’re reading this Notice of Funding Opportunity (NOFO) (also known as “Instructions” on Grants.gov) and reviewing or preparing the workspace application package, you will automatically be notified in the event HRSA changes and/or republishes the NOFO on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note, you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the personnel requirements, assurances, certifications, project abstract, and project narrative. For the NAT Program, budgets and staffing plans are not required. 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)).

Current recipients of a NAT award must submit a New/Competing Continuation application (see program definitions in Section VIII) for each annual open competition to be considered for funding beyond the previous period of performance.

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 30 pages when printed by HRSA. The page limit includes the abstract, project narrative, and attachments including Biographical Sketches (biosketches) 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 limitation. Biographical Sketches do 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 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).

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

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

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

Program-Specific Instructions

Accreditation Applicants must submit official documentation of accreditation in Attachment 2 for all affiliated nursing programs. Applicants who fail to submit accreditation documentation will be considered nonresponsive and deemed ineligible under this funding announcement.

Program Requirements Successful applicants will be required to conduct the following activities:

1. Identify eligible students enrolled in accredited, graduate-level nurse anesthesia degree programs;

2. Provide traineeship awards to those students (minimum $1,000 and maximum $22,000 per student per year) consistent with terms outlined in Section II.2 (Summary of Funding); and

3. Collect and report student and graduate-level data to allow for accurate and timely reporting of required Performance Measures.

Successful applicants are encouraged to connect program graduates with the HRSA Health Workforce Connector, a resource to search for healthcare jobs in underserved communities across the nation.

Successful applicants are also encouraged to request beneficiaries (trainees-students) to apply for a National Provider Identifier (NPI) number and then collect the NPI numbers of those who receive funds as a result of this award for the purpose of collecting post-graduation employment demographics for at least one year, as applicable.

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the personnel requirements, assurances, certifications, project abstract and project narrative), please 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 clinical priorities will be addressed by the project (reference Section

I.1 Program Funding Opportunity Description - Purpose), as applicable; and http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://connector.hrsa.gov/connector/ https://connector.hrsa.gov/connector/ http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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.

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 internal HRSA 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

Successful applications must describe the Purpose and Need for the proposed project, including:

Discuss why, in both qualitative and quantitative terms, the applicant institution needs these funds and how the proposed new project activities that would be supported by this funding would strengthen the applicant’s ability to increase the number of CRNAs in the nation, and/or improve the distribution of the national CRNA workforce to help mitigate CRNA workforce shortages in rural and/or underserved settings;

Describe the need for CRNAs in the benefiting community;

Describe how the community (communities) of focus will benefit from an increased magnitude/improved distribution of CRNAs - and include information on the demographics of the population served, the health status and unmet needs of the community, and other important factors (such as health literacy rates, social determinants of health, barriers to care, rural and/or underserved status, and other elements) in support of your proposal;

Document how the project will use training models and/or address one of the HRSA priorities which may include telehealth activities (reference Section 1.1 Program Funding Opportunity Description – Purpose – Program Priorities);

Discuss the NAT Program’s strategy to prepare HRSA-supported students in experiential training or didactic and clinical experiences in proper pain management and in mitigating the opioid crisis (for example, training in proper opioid prescription, treatment for Substance Use Disorders (SUDs) including Opioid Use Disorders (OUDs), and the administration of Medication Assisted Treatment (MAT)); and

Describe characteristics of your particular nurse anesthesia program, student population, and relevant graduate outcomes – to include the success (pass) rate of your graduates on the national certification examination from the American Association of Nurse Anesthetists (AANA) Council on Certification of Nurse Anesthetists – and discuss the projected impact that this award would have on these.

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

(a) Methodology/Approach; (b) Work Plan; and (c) Resolution of Challenges

(a) METHODOLOGY/APPROACH

In this section, you must describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs.

Specifically, you must

Propose methods that you will use to address the stated needs and meet each of the previously described Program Requirements and expectations in this NOFO;

As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve patients, families, and communities;

Include a plan to disseminate reports, products, and/or project outputs so project information is provided to key target audiences, if applicable;

Explain why your project is innovative and provide the context of why it is innovative, if applicable;

Identify clear strategies and/or activities to address the community and system needs identified above;

Explain the rationale and evidence base behind proposed activities;

Present a clear connection between the identified needs, the proposed activities, the projected outcome measures relative to NAT Program purpose, and the expected impact on the community;

Describe the approach to making awards to trainees, e.g., timing/frequency of award(s), amount;

Describe how trainees will be selected and where they will train, particularly those clinical training sites affiliated with the proposed project that are located in HPSAs, or that benefit rural or underserved populations;4 and

Describe how you use award beneficiaries’ National Provider Identifier (NPI) number to collect post-graduation employment demographics including where they are working in rural/underserved communities.

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

Goals of the project (e.g., objectives);

Assumptions (e.g., beliefs about how the program will work and support resources.

Base assumptions on research, best practices, and experience);

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

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

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

4 See HRSA’s HPSA Finder Tool at https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx

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

Outcomes (i.e., the results of a program, typically describing a change in people or systems, the number of future Certified Registered Nurse Anesthetists trained each project/budget year).

(b) WORK PLAN

You must provide a detailed Work Plan that demonstrates your experience implementing a project of the proposed scope. A sample work plan can be found here:

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

You must:

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

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

Explain how the Work Plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation;

Identify meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the populations and communities served; and

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

(c) RESOLUTION OF CHALLENGES

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the Work Plan, and approaches that you will use to resolve such challenges.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability

(a) Evaluation and Technical Support Capacity

You must describe the plan for Program Performance Evaluation that will contribute to work in continuous quality improvement. The Program Performance Evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project.

Include descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, 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. The Program Performance Evaluation should include use of beneficiaries NPI numbers to determine the number of students who complete the program http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx and are working in rural/underserved areas for at least one year post graduation. You must demonstrate evidence that the Evaluative Measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project. You must also describe the systems and processes that will support your organization's collection of HRSA’s Performance Measurement requirements for this program. At the following link, you will find the required data forms for this program:

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

Describe the data collection strategy to collect, manage, analyze and track data (e.g., assigned skilled staff, data management software) to measure process and impact/ outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes. Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature. You must describe any potential obstacles for implementing the Program Performance Evaluation and meeting HRSA’s Performance Measurement requirements and your plan to address those obstacles. The Evaluation and Reporting Plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

You must include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections. Additional information on RCQI is available at the following website: http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/.

(b) Project Sustainability

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

Highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices;

Obtain future sources of potential funding; as well as provide a timetable for becoming self-sufficient;

Sustain key elements of the project, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population;

Discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges;

Support all program requirements beyond the federal investment; and

Leverage past program participants for future training and partnership opportunities.

http://bhw.hrsa.gov/grants/reporting/index.html http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project, including:

Your organization’s current mission and structure, including an organizational chart of the School of Nursing or Department that houses the Nurse Anesthesia Program, relevant experience, and scope of current activities;

Describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations;

Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings; and

Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

A Biographical Sketch for the Project Director (PD) and any other key faculty/staff (See Section IV.2.vi for full list of required attachments) must be uploaded as Attachment 3.

Include Biographical Sketches for persons occupying key positions, not to exceed TWO pages in length each. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

Biographical Sketches should include the following:

Senior/key personnel name

Position Title

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

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

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

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

iii. Budget

The NAT Program is a formula-based grant program that does not require submission of a budget.

iv. Budget Justification Narrative

The NAT Program is a formula-based grant program that does not require submission of a Budget Justification Narrative.

v. NAT Program Specific Data Forms (NAT Table 1 and NAT Table 2)

As part of the application submitted through Grants.gov, applicants must also complete and electronically submit the NAT Program Specific Data Forms by the established and published application due date. The NAT Program Specific Data Forms are essential to determining the award calculation. These NAT Program Specific Data Forms are part of the electronic Grants.gov application package. Copies of the NAT Program Specific Data Forms (NAT Tables) are included for reference as an appendix to this NOFO; however, the tables must be completed online as a part of the Grants.gov application package.

vi. Attachments

Please provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. You must clearly label each attachment.

Attachment 1: Maintenance of Effort Documentation (Required) You must provide a baseline aggregate expenditure for the prior fiscal year and an estimate for the next fiscal year using a chart similar to the one below. HRSA will enforce statutory MOE requirements through all available mechanisms.

NON-FEDERAL EXPENDITURES

FY 2018 (Actual)

Actual FY 2018 non-federal funds, including in-kind, expended for activities proposed in this application.

Amount: $_____________

FY 2019 (Estimated)

Estimated FY2019 non-federal funds, including in-kind, designated for activities proposed in this application.

Amount: $______________

Attachment 2: Accreditation Documentation (Required) Approval Documentation (If Applicable) The applicant organization must provide evidence of accreditation for all affiliated nursing programs: (1) a statement that they hold continuing accreditation from the relevant accrediting body and are not on probation, (2) the name of the accrediting body, (3) the date of initial accreditation, (4) the date of the next expected accrediting body review (or expiration date of current accreditation), and (5) a web link to the accreditation information on the accrediting body website (if available). The full Letter of Accreditation is not required.

Applicants on provisional accreditation status must provide proof of this status. Information that cannot be verified at the accrediting body website and applications that do not include the required accreditation documentation as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

• Substantive Change Notification Accredited nursing programs that modify (for example, a change from an MSN to a DNP Program) or add a nursing specialty that require substantive change notification to the national nursing accrediting body must include documentation of such approval of the change from the accrediting agency.

• Newly Established Programs of Nursing Accreditation

A new program of nursing (in operation) that, by reason of an insufficient period of operation, is not, at the time of the submission of an application, eligible for accreditation by such a recognized body or bodies or state agency, shall be deemed accredited for the purposes of this title if the Secretary of Education finds, after consultation with the appropriate recognized state approval or accrediting body or bodies, that there is reasonable assurance that the program will meet the accreditation standards of such body or bodies prior to the beginning of the academic year following the normal graduation date of students of the first entering class in such a program. The Letter of Reasonable Assurance from the U.S. Department of Education must be submitted with the application.

The applicant organization must provide full documentation of all approvals (if applicable) needed to enroll students into a new graduate program (i.e., Doctor of Nursing Practice (DNP/DrNP), Doctor of Nurse Anesthesia Practice (DNAP), Doctor of Philosophy (PhD)).

This includes approval from the school, the college/university and the State Board of Nursing, as appropriate. The documentation should be, for example, in the form of meeting minutes, a letter from the State Board of Nursing, or a letter from the Faculty Senate or State Finance Board as appropriate for the school. Applications that do not include the approval documentation and cannot be verified on the website (if applicable) as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

Attachment 3: Biographical Sketch of Project Director (Required) Include a Biographical Sketch for the Project Director, not to exceed two pages in length. If applicable, include other relevant key staff.

Attachment 4: Other Relevant Documents (If applicable) Include any other document that is relevant to the application.

Dun and Bradstreet Universal Numbering System (DUNS) and System for Award Management

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

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

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

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

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

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

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

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

UPDATED SAM.GOV ALERT: For your SAM.gov registration, you must submit a notarized letter appointing the authorized Entity Administrator. The review process changed for the Federal Assistance community on June 11, 2018. Read the updated FAQs to learn more about this and the current login process for SAM.gov.

http://www.dnb.com/duns-number.html https://www.sam.gov/ http://www.grants.gov/ https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/sam-update

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

4. Submission Dates and Times

Application Due Dates The due date for applications under this NOFO is April 15, 2019 at 11:59 p.m. ET. HRSA suggests submitting applications to Grants.gov at least 3 days before the due date to allow for any unforeseen circumstances. See Section 8.2.5 – Summary of emails from Grants.gov in HRSA’s SF-424 R&R Application Guide for additional information.

5. Intergovernmental Review

The Nurse Anesthetist Traineeship Program is not a program subject to the provisions of Executive Order 12372, as implemented by 45 CFR 100.

See Section 4.1 ii of HRSA’s SF-424 R&R Application Guide for additional information.

6. Funding Restrictions

You may request funding for a period of performance of 1 year in direct costs only.

The General Provisions in Division B of the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-245) apply to this program. Please see Section 4.1 of HRSA’s SF-424 R&R Application Guide for additional information.

You can use funds under this notice for the following purposes:

1. To provide traineeships (minimum $1,000 and maximum $22,000 per eligible student per year) to eligible students enrolled in accredited, graduate-level nurse anesthesia degree programs

2. Full or partial costs of the tuition and fees

3. Required books/e-books

4. Reasonable living expenses (stipends)

You cannot use funds under this notice for the following purposes:

1. Trainee travel

2. Trainee daily commuting costs

3. Non-trainees’ expenses, e.g. personnel costs-staff salaries, consultant costs, equipment, research supplies, travel expenses for the faculty, etc.

4. Indirect Facilities and Administration (F&A) Costs

You are required to have the necessary policies, procedures and financial controls in place to ensure that your organization complies with all legal requirements and restrictions applicable to the receipt of federal funding including statutory restrictions on use of funds for lobbying, executive salaries, gun control, abortion, etc.