PKG00250101-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Medical Student Education Program

Funding Opportunity Number: HRSA-19-101 Funding Opportunity Type: New

Assistance Listings (CFDA) Number 93.680

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: June 14, 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: April 15, 2019

Anthony Anyanwu Public Health Analyst Division of Medicine and Dentistry E-mail: aanyanwu@hrsa.gov Telephone: (301) 443-8437 Fax: (301) 443-0162

Authority: Division B, Title II 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).

mailto:aanyanwu@hrsa.gov i

HRSA-19-101

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2019 Medical Student Education Program (MSE). The purpose of the MSE Program is to provide grants to public institutions of higher education to expand or support graduate education for medical students preparing to become physicians in the top quintile of states with a projected primary care provider shortage in

2025.1 The program is designed to prepare and encourage medical students who are training in the most underserved states to choose residencies and careers in primary care that serve tribal communities, rural communities, and/or medically underserved communities (MUCs) after they graduate. Priority is given to applications from universities in states with the greatest number of federally-recognized tribes and from public universities with demonstrated private-public partnerships.

Funding Opportunity Title: Medical Student Education Program

Funding Opportunity Number: HRSA-19-101

Due Date for Applications: June 14, 2019

Anticipated Total Available FY19 - FY22 Funding:

$23,750,000

Estimated Number and Type of Awards: Up to 5 Grants

Estimated Award Amount: Not less than $1,000,000 per year; but not more than $1,180,000 per year

Cost Sharing/Match Required: Yes. 10 percent matching of the total annual amount of federal funds each year.

Period of Performance: September 1, 2019 through August 31, 2023 (4 years)

Eligible Applicants: Awards are limited to the 12 public colleges of medicine in Mississippi, Alabama, Kentucky, Oklahoma, Utah, Arkansas, Missouri, and Indiana.

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

1 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015.

“State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016.

Accessed: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf.

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf ii

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 Notice of Funding Opportunity (NOFO) to do otherwise.

Technical Assistance

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

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

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

Table of Contents

PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

I. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

II. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

III. 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

IV. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Medical Student Education (MSE) program.

Program Purpose The purpose of the MSE Program is to provide grants to public institutions of higher education to expand or support graduate education for medical students preparing to become physicians in the top quintile of states with a projected primary care provider shortage in 2025.2 The program is designed to prepare and encourage medical students training in the most underserved states to choose residencies and careers in primary care that serve tribal communities, rural communities, and/or medically underserved communities (MUCs) after they graduate. This will be accomplished by supporting the development of medical school curricula, clinical training site partnerships, and faculty training programs, with the goal of educating medical students who are likely to choose career paths in primary care, especially for tribal communities, rural communities, and/or MUCs.

Program Goal The overarching goal of the MSE Program is to increase the number of primary care physicians who practice in underserved communities in top quintile of states with a projected primary care provider shortage in 2025.

Award recipients must develop and implement new and/or expanded preclinical and clinical medical school curricula/training tracks/branch campuses that will prepare medical students to acquire the knowledge, skills, and abilities to assess and address the primary care needs of individuals living in states with primary care shortages, especially within tribal communities, rural communities, and/or MUCs. Curricula should, to the extent possible, include:

education on identifying and addressing population health needs;

consideration of social determinant of health factors in patient care plan development;

enhancement of student cultural and linguistic competency;

integration of patient behavioral health care into primary care practice (including prevention and treatment of opioid and other substance use disorders);

use of telehealth technology;

health systems-level education – such as work in transforming/transformed practice environments (i.e., those enhancing patient experiences, improving care quality and population health, reducing costs, and improving the work life of health care provider teams);

care for vulnerable populations; and

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015.

“State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016.

Accessed: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf.

practice within tribal communities, rural communities, and/or MUCs

Curricula should focus on preparing medical students for a transition into primary care residency training and future practice, enhancing their aptitude in providing care to underserved, high-need patient populations, as well as preparing them to effectively deliver high quality primary care services in resource-limited settings. Award recipients will be expected to see an increase in their rates of graduates entering primary care residency programs that are in and/or primarily serve rural and other underserved populations.

Program Objectives

Grow the primary care physician workforce in tribal communities, rural communities, and/or MUCs by strengthening medical school programs in these areas.

Encourage practice transformation, which includes educational and training activities that target the specific skills and competencies needed to prepare medical students to work and practice in tribal communities, rural communities, and/or MUCs.

Recruit and retain medical students from tribal communities, rural communities, and/or MUCs and encourage primary care residency programs.

Develop and implement educational and training activities for medical students through strategic partnerships.

Funding Priorities HRSA will give priority to:

Applications from universities located in states with the greatest number of federally-recognized tribes based on the Bureau of Indian Affairs (BIA)’s list of recognized tribal entities.3

Applications from public universities with demonstrated public-private partnerships.

The instructions and criteria for each funding priority are provided in Section V.2.

2. Background

This program is authorized by Division B, Title II 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).

Research shows that a strong primary care foundation is critical for health care system performance and improved health of the population.4 Access to high quality primary

3 Department of the Interior. Bureau of Indian Affairs. “Indian Entities Recognized and Eligible To Receive Services from the United States Bureau of Indian Affairs”. 83 FR 34863. Accessed: https://www.gpo.gov/fdsys/pkg/FR-2018- 07-23/pdf/2018-15679.pdf. List by State at the National Conference of State Legislators, Updated November 2018.

Accessed: http://www.ncsl.org/research/state-tribal-institute/list-of-federal-and-state-recognized-tribes.aspx.

4 Starfield B., Shi I, Macinko, J. Contributions of primary care to health systems and health. Millbank Quarterly 2005, 83: 457-502. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-0009.2005.00409.x https://www.gpo.gov/fdsys/pkg/FR-2018-07-23/pdf/2018-15679.pdf https://www.gpo.gov/fdsys/pkg/FR-2018-07-23/pdf/2018-15679.pdf http://www.ncsl.org/research/state-tribal-institute/list-of-federal-and-state-recognized-tribes.aspx https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-0009.2005.00409.x https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-0009.2005.00409.x care is also associated with improved health outcomes and lower costs.5 However, substantial disparities exist in the distribution of primary care providers. Shortages of health care providers affect rural areas more than other more densely populated areas, and these areas often face significant health challenges and health disparities.6,7

American Indians and Alaska Natives tend to have lower health status, lower life expectancy, and a disproportionate disease burden when compared to other Americans which may be due to inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. 8 While the demand for health professionals in tribal communities is high, the vacancy and turnover rates for these positions are also high. One reason is that most of the health care professionals practicing in tribal communities tend to come from off reservation and research shows that there is a high turnover rate for non-Native health professionals working on reservations.9 Having training experiences in, living in, and being from tribal communities increases cultural awareness and can further influence career choice for physicians to better serve tribal populations.

A number of strategies are effective in promoting providers to choose careers in primary care and in rural and underserved areas. These include, but are not limited to, exposure to role models, health professional school culture, education in public institutions, positive training experiences in rural and underserved communities, and practice location.10,11 Studies indicate that exposure to rural training can also increase recruitment and retention; however, the bulk of training continues to take place in urban and suburban areas.12,13,14 Research shows that there is a relationship between physician characteristics (such as being part of an underrepresented minority or growing up in a rural area) and eventual practice location. Therefore recruiting these students and exposing them to trainings in community and underserved settings will

5 Chang CH, O'Malley AJ, Goodman DC. Association between Temporal Changes in Primary Care Workforce and Patient Outcomes. Health Services Research 2017; 52:634–55.

6 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015.

“State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016.

Accessed: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf.

7 Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Voong, A. M., Kasha, B. A., Schulze, A. and Held user, J. W. (2015), Rural Healthy People 2020: New Decade, Same Challenges. The Journal of Rural Health, 31: 326–333.

doi:10.1111/jrh.12116.

8 Indian Health Services Fact Sheets: Indian Health Disparities. (April 2018). Indian Health Services. Retrieved March 7, 2019 at https://www.ihs.gov/newsroom/factsheets/disparities/.

9 Katz, Janet et al. Retention of Native American Nurses Working in Their Communities (October 2010). Journal of Transcultural Nursing, Volume 21(4), October 2010, p 393–401.

10 Washko, M. M., Snyder, J. E., & Zangaro, G. (2015). Where do physicians train? Investigating public and private institutional pipelines. Health Affairs, 34(5), 852-856. https://doi.org/10.1377/hlthaff.2014.1356.

11 Connelly MT, et al. Variation in Predictors of Primary Care Career Choice by Year and Stage of Training. JGIM.

2003; 18(3): 159-69.

12 Rabinowitz, H., Diamond, J., Markham, F., Wortman J. (2008). Medical School Programs to Increase the Rural Physician Supply: A Systematic Review and Projected Impact of Widespread Replication. Academic Medicine; 83(3):

235-243.

13 Patterson DG, Andrilla CHA, Larson EH. Graduates of Rural-centric Family Medicine Residencies: Determinants of Rural and Urban Practice. Policy Brief #159. Seattle, WA: WWAMI Rural Health Center, University of Washington, July 2016.

14 Patterson DG, Schmitz D, Longenecker R, Andrilla CHA. Family medicine Rural Training Track residencies: 2008- 2015 graduate outcomes. Seattle, WA: WWAMI Rural Health Research Center, University of Washington. Feb 2016.

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf https://www.ihs.gov/newsroom/factsheets/disparities/ more likely result in them practicing in similar settings after graduation.15,16,17 Recent studies have also noted that interprofessional experiences in primary care didactic and clinical practice have a positive effect on health care outcomes and student selection of careers in primary care. These curricular additions with multiple disciplines have been shown to affect choice of careers in primary care.18 There is also increasing evidence that interprofessional education and practice results in increased collaboration and coordination that improves health outcomes, increases provider and consumer satisfaction, and improves coordination by effective use of resources.

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 MSE Program for Fiscal Year 2019.

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

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

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

Longitudinal clinical training experience means a long term (e.g., 3 months or longer) clinical experience with a clinical partner, focusing on the care of tribal communities, rural communities, and/or MUCs.

Partner/Consortium means an organization or group of organizations that provide(s) resources and/or support to grantees for the implementation of educational and training programs and/or activities.

15 Phillips, RL; Petterson, S; Bazemore, A. Do Residents Who Train in Safety Net Settings Return for Practice?

Academic Medicine: 2013; 88(12): 1934–1940.

16 Goodfellow A, Ulloa J, Dowling P, Talamantes E, Chheda Somil, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. 2016, Academic Medicine.

17 Mc-Ellistrem-Evenson, A. (2011). Informing Rural Primary Care Workforce Policy: What Does the Evidence Tell Us?: A Review of Rural Health Research Center Literature, 2000-2010.

18 William R. Phillips, MD, MPH; Toby Keys, MA, MPH Interprofessional Course Curriculum and Primary Care, Family Medicine 2018; 15 (3): 217-222. Vol. 50 No. 3 March 2018.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/grants/resourcecenter/glossary http://journals.lww.com/academicmedicine/Abstract/publishahead/Predictors_of_Primary_Care_Physician_Practice.98509.aspx http://journals.lww.com/academicmedicine/Abstract/publishahead/Predictors_of_Primary_Care_Physician_Practice.98509.aspx http://journals.lww.com/academicmedicine/Abstract/publishahead/Predictors_of_Primary_Care_Physician_Practice.98509.aspx

Practice Transformation means health systems-level education – such as exposure to transforming/transformed practice environments (i.e., those enhancing patient experiences, improving care quality and population health, reducing costs, and improving the work life of health care provider teams). Practice Transformation aims to fully support quality improvement and patient-centered care through goal-setting;

leadership; practice facilitation; workflow changes; individual, community and population level approaches; measuring outcomes; and adapting organizational tools and processes to support new team-based models of care delivery.

Stipend means a payment to an individual to help meet that individual's living expenses during the training period. The receipt of a stipend under this program does not create an employment relationship with either the federal government or the sponsoring organization/sub recipient.

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. For medical student education, the term “telehealth” may include activities such as teleprecepting, telementoring and/or distance learning.

Vulnerable Populations means groups of individuals at higher risk for health disparities by virtue of their race or ethnicity, socio-economic status, geography, gender, age, disability status, or other risk factors associated with sex and gender.

I. Award Information

1. Type of Application and Award

Type of applications sought: New.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $23,750,000 to be available in fiscal years 2019 – 2022 to fund up to five (5) grants among the 12 eligible medical schools. You may apply for an amount of not less than $1,000,000 per year, to a maximum of $1,180,000 per year.

The period of performance is four (4) years, from September 1, 2019 through August 31, 2023. Funding is available beyond the first year, subject to satisfactory award 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.

Indirect costs under training awards to organizations other than state, local, or Indian Tribal governments will be budgeted and reimbursed at 8 percent of modified total direct costs, rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts exclusive of equipment, tuition and fees, and sub-awards/subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

II. Eligibility Information

1. Eligible Applicants

The MSE Program’s authorization requires the Secretary to give priority to public institutions of higher education located in States with a projected primary care provider shortage in 2025, as determined by the Secretary, and awards are limited to such public institutions of higher education in the top quintile of States with a projected primary care provider shortage in 2025.

In determining the eligible applicants for the MSE Program, HRSA used the November 2016 “State-Level Projections of Supply and Demand for Primary Care Practitioners:

2013-2025” report by HRSA’s National Center for Health Workforce Analysis to identify the states with a projected primary care provider shortage in 2025. HRSA ranked states based on their projected levels of primary care provider “adequacy”19 in 2025, and 37 states are projected to have a shortage of primary care physicians.20 The report notes that using a percentage of the state’s 2025 demand (i.e., adequacy) helps to inform comparisons of differences between supply and demand across states by considering how the size of each state’s surplus or shortage relates to that state’s underlying provider demand. A negative adequacy indicates a likely shortage in 2025 and reflects the percentage of 2025 demand that is unmet.

19 Adequacy is defined as the projected 2025 state-level provider shortage or surplus expressed as a percentage of that state’s 2025 provider demand. A negative adequacy indicates a shortage (i.e., supply is less than demand) while a positive adequacy indicates a surplus (i.e., supply is greater than demand).

20 U.S. Department of Health and Human Services, Health Resources and Services Administration. HRSA, 2015.

“State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.” November 2016.

Accessed: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf

The top quintile of the 37 states with a shortage in 2025 would be 7.4 states. However, because the difference in adequacy scores between the seventh and eighth position was less than one percentage point, HRSA rounded up to include the top eight states:

Mississippi, Alabama, Kentucky, Oklahoma, Utah, Arkansas, Missouri, and Indiana.

HRSA then identified accredited Osteopathic and Allopathic medical schools in those eight states using the Commission on Osteopathic College Accreditation (COCA) and Liaison Committee on Medical Education (LCME), selecting only those that identified as public, non-profit colleges of medicine.21 This resulted in 12 public, non-profit colleges of medicine within the eight states that are potentially eligible for MSE funding.

Therefore, HRSA has determined that the eligible applicants for this funding opportunity are limited to accredited public colleges of medicine in Mississippi, Alabama, Kentucky, Oklahoma, Utah, Arkansas, Missouri, and Indiana. HRSA has identified the following accredited public colleges of medicine in these eight states in the table below.

The listing below is not intended to foreclose applications by applicants that can demonstrate to HRSA that they are accredited public colleges of medicine in one of the eight listed states. HRSA may consider any application that does not meet the eligible applicant requirement non-responsive and may consider it ineligible for funding under this notice.

State Entity Location

Alabama University of Alabama School of Medicine Birmingham

Alabama University of South Alabama College of Medicine Mobile

Arkansas University of Arkansas for Medical Sciences College of Medicine

Little Rock

Indiana Indiana University School of Medicine Indianapolis

Kentucky University of Kentucky College of Medicine Lexington

Kentucky University of Louisville School of Medicine Louisville

Mississippi University of Mississippi School of Medicine Jackson

Missouri University of Missouri-Columbia School of Medicine

Columbia

Missouri University of Missouri-Kansas City School of Medicine

Kansas City

Oklahoma University of Oklahoma College of Medicine Oklahoma City

Oklahoma Oklahoma State University College of Osteopathic Medicine

Tulsa

Utah University of Utah School of Medicine Salt Lake City

21 For allopathic medical schools, HRSA used the Liaison Committee on Medical Education Directory of Accredited MD Programs in the United States. Access: http://lcme.org/directory/accredited-u-s-programs. For Public/Private Status HRSA used the Tuition and Student Fees workbook from Association of American Medical Colleges. Access:

https://www.aamc.org/data/tuitionandstudentfees.

For osteopathic medical schools and Public/Private status, HRSA used the American Osteopathic Association’s Commission on Osteopathic College Accreditation, 2018-2019 Osteopathic Medical College Information Book.

Access: https://www.aacom.org/news-and-events/publications/2018-2019_cib.

http://lcme.org/directory/accredited-u-s-programs https://www.aamc.org/data/tuitionandstudentfees https://www.aacom.org/news-and-events/publications/2018-2019_cib

2. Cost Sharing/Matching

The MSE Program’s authorization requires an amount not less than ten percent matching of the total annual amount of federal funds provided each year in the grant to each award recipient. Higher degrees of matched funding are allowable and may help award recipients develop more transformative plans and achieve greater health workforce outcomes. Matching funds are any non-federal funds that contribute to the project purpose and objectives, such as in-kind faculty contributions, facilities, and contributions from partnerships (45 CFR 75.306). Applications that fail to address cost sharing/matching requirements will be deemed ineligible and not considered for funding under this notice.

3. Other

Ceiling Amount This award may not be less than $1,000,000 per year and there is a ceiling amount of no more than $1,180,000 per year. HRSA may consider any application that is below $1,000,000 annual budget or exceeds the ceiling amount as non-responsive and may consider it ineligible for funding under this notice.

Deadline The deadline for this NOFO is June 14, 2019 at 11:59 p.m. Eastern Time. HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Multiple Applications NOTE: Multiple applications from an organization with the same DUNS number are not allowable. No more than one application per organization or campus with the same DUNS number will be funded. The applicant may include a request for resources for a branch campus or similar entity as part of their application.

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

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

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

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III. 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.

The NOFO is also known as “Instructions” on Grants.gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including modifications and/or republications of the NOFO on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note, you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the applications in the English language and in terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 65 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the workspace application package do NOT count in the page limit. Biographical Sketches do count in the page limit.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

https://www.grants.gov/ https://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You, on behalf of the applicant organization certify, by submission of your proposal, that neither you nor your principals are 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 you are unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 8: Other Relevant Documents.

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

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

Program Requirements

Applicants must:

Develop and implement new and/or expanded longitudinal, interprofessional team-based program curricula that implements a defined set of clinical, didactic, and community-based training activities with an emphasis on practicing in tribal communities, rural communities and/or MUCs, and how to meet the needs of vulnerable populations.

Focus on developing and implementing educational and training curricula that teach the broad skill set required for primary care practice, including caring for individuals from tribal communities, rural communities, and/or MUCs.

Support or expand community-based experiential training in tribal communities, rural communities, and/or MUCs through field placements and related types of clinical experiences for the medical students. Each training experience must include a formal, didactic component addressing the Core topic areas. (See below for a list of Core Topic areas).

Develop and operate a program for the training of medical students who will provide primary health care services.

Increase the capacity of the faculty who train the medical students in the Core Topic Areas. Faculty development activities may be needed to carry out the program improvement and activities such as expanding or developing educational opportunities around interprofessional team based care, telehealth, opioid and other substance use disorders, mental health screening, and treatment in primary care. Faculty may need applied experience in longitudinal clinical education at the partner site with an emphasis in tribal communities, rural http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf communities, and/or MUCs in order to implement these learning experiences for their medical students.

Ensure all educational and training activities expand or support new educational programming for students in the following six (6) Core Topic Areas:

o Interprofessional Education (interdisciplinary training), which supports a coordinated, patient-centered model of health care that involves an understanding of the contributions of multiple health care professionals;

o Behavioral Health Integration which promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health, depression, opioid and other substance use disorders who seek care in the primary care setting;

o Social Determinants of Health which includes five key areas (determinants) [Economic Stability, Education, Social and Community Context, Health and Health Care, and Neighborhood and Built Environment] and their impact on health;

o Cultural and linguistic competency which seeks to improve individual health and build healthy communities by training health care providers to recognize and address the unique culture, language and health literacy of multiple consumers and communities and provide culturally and linguistically competent health care (e.g., National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care);

o Practice transformation which includes educational and training activities which target the specific skills and competencies needed to prepare students and practicing health professionals to effectively practice in a transforming health care system; and o Use of Telehealth Technology such as teleprecepting, telementoring, distance learning, live video, remote patient monitoring, or other technology, as appropriate.

Develop and implement educational and training activities through new or expanded scope of work for existing, strategic partnerships between academia, federally-recognized Tribes, tribal colleges, tribal organizations, primary care delivery sites or systems, and/or community-based organizations to educate and train medical students to provide care that improves health outcomes for individuals living in tribal communities, rural communities, and/or MUCs.

o Applicants who do not have an existing partnership are required to provide evidence through a memorandum of understanding that they have a plan to establish agreements with one or more partners within 6 months of the project start date. The partnership must be with an organization that supports the goals and purpose of the project and the medical school program. Applicants also need to describe the proposed partners and document their agreement through letters of support and memoranda of agreement, including any contributions (either in kind or subawards).

Applicants must provide a detailed budget and justification narrative for all subawards.

o So long as partnership activities are not already being supported by the Federal Government through other programs/means of federal support, partnering organizations may include (but are not limited to) the following organizations:

State-level entities such as State and Local Workforce Agencies, federally-recognized tribes, Primary Care Associations (PCAs), Primary Care Offices (PCOs), State Offices of Rural Health (SORH), State Minority Health Contacts, and State Education Agencies.

Health Care Safety Net Sites (e.g., Federally-Qualified Health Centers (FQHCs) and Look-Alikes, including school-based health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers), Native Hawaiian Health Centers, outpatient health clinics associated with tribal or Urban Indian Health Organizations, Rural Health Clinics, Critical Access Hospitals (CAH), and Disproportionate Share Hospitals.

Programs such as HRSA’s Health Careers Opportunity Programs (HCOPs), Centers of Excellence (COE) programs, and Area Health Education Centers (AHECs), as well as other recruitment programs through health professions schools and educational institutions.

Minority-serving institutions such as Historically Black Colleges and Universities, Hispanic Serving Institutions, and tribal Colleges and Universities in the state and region.

Develop a plan to collect post-graduation employment demographics with graduates from medical school for at least 1 year after graduation and after they complete their residency. As a best practice, award recipients should also encourage medical students to apply for a National Provider Identifier (NPI)22 number and collect the NPI numbers of medical students who receive stipends/traineeship funds. Medical students are typically eligible to obtain NPI numbers, which are useful for HRSA and the program in tracking the students and graduates of the program for determining the impact of the HRSA-funded program on increasing access to primary care services to tribal communities, rural communities, and/or MUCs. In circumstances where the medical student does not have an NPI, HRSA will collect the Health Provider taxonomy coding in lieu of the NPI.

Provide, implement, and evaluate methods to improve the recruitment and retention of medical students from tribal communities, rural communities, and/or MUCs.

22 For more information on the National Provider Identifier please visit: https://www.cms.gov/Regulations-and- Guidance/Administrative-Simplification/NationalProvIdentStand/ and https://nppes.cms.hhs.gov.

https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/ https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/ https://nppes.cms.hhs.gov/

i. Project Abstract

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

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

Project Title

Program Name: Medical Student Education Program

Applicant Organization Name

Address

Project Director Name and credentials

Contact Phone Number

Email Address

Website Address, if applicable

Number of Medical Students Trainees projected per Year

Period of performance

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

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; and

4. Request for funding priority, if applicable.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

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

Briefly describe the purpose of your proposed project and describe how the shortages and need for additional primary care physicians in the state, especially for primary care physicians in tribal communities, rural communities, and/or MUCs, is impacting the communities that your medical school is serving. Describe the gaps in outreach and comprehensive care that will need to be added to the services. To the extent possible, include data on the demographics, social determinants of health/health disparities faced by, and health care needs of the population served, with a focus on tribal communities, rural communities, and/or MUCs.

Describe the unmet education and training needs of the medical students that will participate in this project related to interprofessional, team-based didactic and experiential learning, exposure to telehealth, opioid and other substance use disorder prevention and treatment, mental health assessment, and primary mental health care.

Describe the characteristics of any current existing partners that align with the purposes of this project and additional needs to add to their scope of work or how new partnerships will be created. Applicants may qualify for a funding priority on the basis of their description of existing public-private partnerships that contribute to the goals of the program. All applicants must document plans for developing new partners or expanding existing ones.

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

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

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

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

You must:

Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section. Be clear about how these proposed activities, that potentially will be made possible through HRSA support, will be new or enhanced from what is already being done at the institution as a direct result of receiving funding.

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

Describe curriculum enhancements and activities to develop clinical sites in tribal communities, rural communities, and/or MUCs.

Describe how you will ensure that new and/or expanded clinical learning sites will provide high quality educational experiences for students.

Describe recruitment and retention strategies and activities to increase enrollment and graduation of medical students from tribal, rural and/or MUC backgrounds. This may include collaboration with tribal colleges and programs aimed at promoting health career opportunities for pre-medical students.

Describe meaningful support and collaboration with current or planned key partners including federally-recognized tribes, tribal colleges, tribal organizations, primary care delivery sites and systems, PCOs, PCAs, HCOPs, COEs, AHECs, SORH, and/or community-based organizations required during the period of performance in planning, designing and http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx implementing all activities, and, further, the extent to which these contributors reflect the populations and communities served. An existing partnership is not a requirement for the program, however it may enable the applicant to qualify for a priority. All applicants either need to expand or strengthen existing partnerships and/or to add new partners that meet the purpose of the project.

o If applicable, provide a copy of the memorandum of understanding and/or letter of support for each current existing partner and for at least one that you plan to develop in the future. Include documentation of the specific contribution that each partner will make to the project.

o If new partnerships are being formed, provide evidence of their agreement and their specific planned contribution.

Describe how specific telehealth modalities are appropriate for the training of the medical students, including, if applicable, teleprecepting, telementoring and/or distance learning, and how these telehealth modalities will be used to provide training and education.

Describe how you will implement formal mechanisms for feedback and evaluation (and institute improvements/remediation, as needed), specifically related to the educational value of clinical training experience for students at the partner site(s). This should include an assessment of student experiences and academic progress. Describe the frequency and depth of communication planned between partner sites and the main academic institution related to program development, curricular enhancements, and use of Rapid Cycle Quality Improvement (RCQI) methods. Describe how the partners will communicate and coordinate with the main academic institution around project planning, progress, evaluations, and resolutions.

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

Propose methods that you will use to address the stated needs and meet each of the previously described program goals and objectives in this NOFO.

In the Methodology section of your application, you must describe:

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

How you will address the program objectives listed in the Purpose section and the Program Requirements in the Program Specific Instructions section (including your activities and methods).

Activities to meet objectives including the roles of partners, system level initiatives, the educational/teaching strategies to be implemented, and curricula/training materials and incorporation of new and/or expanded longitudinal primary care learning experiences that will be used to accomplish the objectives of the project.

How you will enhance current curriculum or develop and implement educational and training curricula that teach the broad…