PKG00255801-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Primary Care Training and Enhancement:

Residency Training in Primary Care (PCTE-RTPC) Program

Funding Opportunity Number: HRSA-20-008 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.884

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: January 24, 2020

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: October 11, 2019

Anthony Anyanwu, MD, MHA, MSc Project Officer, Division of Medicine and Dentistry Email: AAnyanwu@hrsa.gov Telephone: (301) 443-8437 Fax: (301) 443-1945

Authority: Section 747(a) of the Public Health Service (PHS) Act (42 U.S.C. § 293k(a)) mailto:AAnyanwu@hrsa.gov

HRSA-20-008 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Primary Care Training and Enhancement: Residency Training in Primary Care (PCTE-RTPC) Program. The purpose of this program is to enhance accredited residency training programs in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (med-peds) in rural and/or underserved areas, and encourage program graduates to choose primary care careers in these areas. Per PHS Act section 799(a), HRSA is carrying out this strategic workforce supplementation activity to meet the health workforce goal of increasing the distribution of primary care physicians who are ready to practice in and lead the transformation of healthcare systems aimed at improving access, quality of care, and cost effectiveness in rural and/or underserved areas.

The FY 2020 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. You should note that this program may be cancelled prior to award.

Funding Opportunity Title: Primary Care Training and Enhancement:

Residency Training in Primary Care Program (PCTE-RTPC)

Funding Opportunity Number:

HRSA-20-008

Due Date for Applications:

January 24, 2020

Anticipated Total Annual Available FY 2020 Funding:

$10,000,000

Estimated Number and Type of Award(s):

Up to 20 grants

Maximum Award Amount:

Up to $500,000 per year subject to the availability of appropriated funds

Cost Sharing/Match Required:

No

Period of Performance:

July 1, 2020 through June 30, 2025 (Five

(5) years)

HRSA-20-008 ii

Eligible Applicants:

Eligible entities include accredited public or nonprofit private hospitals, schools of allopathic medicine or osteopathic medicine, or a public or private non-profit entity which the Secretary has determined is capable of carrying out a residency training program in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (“med-peds”), which for the purposes of this NOFO are programs accredited by the Accreditation Council for Graduate Medical Education

(ACGME).

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

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

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx 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/default.aspx

HRSA-20-008 iii

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND SYSTEM

FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-20-008 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Primary Care Training and Enhancement: Residency Training in Primary Care (PCTE-RTPC) Program.

Program Purpose The purpose of this program is to enhance accredited residency training programs in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (med-peds) in rural and/or underserved areas, and encourage program graduates to choose primary care careers in these areas.

This funding also supports the development of rural and/or underserved residency tracks within existing accredited residency programs for family medicine, general internal medicine, general pediatrics and combined internal medicine and pediatrics (med-peds) programs.

For purposes of this NOFO, rural and/or underserved areas are identified by two defined sources:

1. Clinical where rotation site is located in a state has a projected shortage of primary care providers in 2025, using the NCHWA shortage projections for primary care shortage for FY2025 https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013- 2025.pdf; and/or

3. Clinical rotation site is located in an area considered rural as determined by the Federal Office of Rural Health Policy (FORHP), using the Rural Health Grants Eligibility Analyzer at https://data.hrsa.gov/tools/rural-health.

Program Goal(s) The overarching goal of this program is to increase the distribution of primary care physicians to rural and/or underserved areas.

Program Objectives

• Grow the primary care physician workforce to meet the needs of rural and/ or underserved areas by strengthening residency training programs in these areas.

• Train residents in interprofessional, team-based care.

• Develop or enhance training to incorporate knowledge, skills and competencies needed to o meet the Department of Health and Human Services (HHS) and HRSA priorities that include combatting the opioid crisis, mental health, transforming the workforce by targeting the need, and telehealth; and o prepare residents to work and practice in rural and/or underserved areas to improve community health outcomes.

• Recruit, retain, and graduate residents from rural and/or underserved areas.

• Increase the number of residency graduates who choose to practice in rural and/or underserved areas.

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

HRSA-20-008 2

• Establish linkages with private sector and safety net health care providers to provide care and improve access to and quality of care in rural and/or underserved areas.

• Develop partnerships with clinical ambulatory sites to provide longitudinal interprofessional learning experiences.

• Develop and provide support for faculty and preceptors development to plan, develop, and operate a program for the training of physicians teaching in community-based settings in rural and/or underserved areas.

HHS Priorities Applicants are encouraged to address the HHS priorities of combating the opioid crisis and strengthening mental health service access through resident clinical training and scholarly projects.

2. Background

This program is authorized by Section 747(a) (42 U.S.C. § 293k(a)) of the Public Health Service Act.

Primary care physicians are confronted with challenges in their practices that encompass access to subspecialty consultation, patients needing medication assisted treatment (MAT), and continuing professional education to have the most up to date knowledge to treat their patients.1,2 To address these barriers, physicians are integrating telehealth technologies into their practices across a broad range of health care services, especially in states that serve large rural populations.3 Several studies have shown that integrating MAT into primary care settings expands access to Opioid Use Disorder treatment.4 The literature indicates barriers to implementing MAT include a lack of trained primary care providers and long travel times for patients in rural areas.5,6 In order to increase the number of MAT prescribing providers, it is important to train residents, especially in the rural and underserved areas, where there is already a shortage of primary care

1 Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and state treatment need and capacity for opioid agonist medication assisted treatment. Am J Public Health. 2015;105:255-63. (PMID:26066931) doi:10.2105/AJPH.2015; 302664.

2 James P. Marcin, Ulfat Shaikh and Robin H. Steinhorn, Addressing health disparities in rural communities using telehealth. Pediatric Research Volume 79, Number 1, January 2016.

3 IBID

4 Cicero, TJ, Ellis, MS; Surratt HL, Kurtz SP. The changing face of heroin use in the United States; a retrospective analysis of the past 50 years. JAMA Psychiatry, 2014:71:821-6. (PMID. 24871348) doi:10.1001/amapyschiatry. 2014.366).

5 Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I Zakher B, et al. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings, Annals of Internal Medicine, 2016, Draft technical brief. (Prepared by the Pacific Northwest Evidence-based Practice Center under contract no 2902915000091.

Rockville: Agency for Healthcare Research and Quality; 22016.

6 P. Todd Korthuis, MD, MPH; Denniss McCarty, PhD; Melissa Weimar, DO, MCR; Christina Bougatsos, MPH; Ian Blazina, MPH; Bernadette Zakher, MBBS; Sara Grusing, BS; Beth Devine, PhD, PharmD, MBA; and Roger Chou, MD.

HRSA-20-008 3

providers.7 Similarly, training residents in the use of telehealth is vital in addressing the pressing needs of people who live in rural areas and lack access to care.8

Twenty percent of the U.S. population reside in rural areas, but only 11.4 percent of physicians are practicing there.9,10 People living in rural areas represent one of the largest underserved U.S. populations for health care access. People who live in rural areas are more likely to be older, sicker, poorer, have less education, and are more likely to be uninsured than are urban residents.11 In addition, most of the federally designated physician shortage areas are in rural areas.12

To eliminate physician shortages and achieve the goal set by HRSA of a population-to physician ratio of 2,000:1, the supply of physicians would need to be increased by 2,670 in rural areas and 3,970 in urban areas. The average ratio across the United States is 1,485:1. Achieving this ratio for all communities would require nearly 7,000 more rural physicians and nearly 13,500 more inner-city physicians.13

Data suggest that medical residents who train in rural settings are two to three times more likely to practice in a rural area.14,15 More than half of family physicians practice within 100 miles of their family medicine residency program (FMRP) (55 percent) and within the same state (57 percent). This suggests that training in rural and/or underserved areas may be a part of the solution to uneven distribution among primary care physicians.16

HRSA is seeking to address the shortage of physicians and improve access to care by targeting clinical training sites in rural and/or underserved areas.

7 Increasing Access to Medication-Assisted Treatment of Opioid Abuse in Rural Primary Care Practices. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD.

https://www.ahrq.gov/ncepcr/primary-care-research/opioids.html.

8 Telehealth Closes Patient Care Access Gaps in Rural Mississippi, https://patientengagementhit.com/news/telehealth-closes-patient-care-access-gaps-in-rural-mississippi.

9 http://depts.washington.edu/uwrhrc/uploads/RHRC_FR125_Rosenblatt.pdf 10 Rural Health Snapshot 2017 (May 2017).

11 Snyder JE, Jensen M, Nguyen NX, Filice CE, Joynt KE. Defining Rurality in Medicare Administrative Data. Med

Care. 2017 Dec;55(12):e164-e169.

12 Critical Factors for Designing Programs to Increase the Supply and Retention of Rural Primary Care Physicians.

Howard K. Rabinowitz, MD; James J. Diamond, PhD; Fred W. Markham, MD; Nina P. Paynter, BS; et al.

JAMA. 2001;286(9):1041-1048. doi:10.1001/jama.286.9.1041.

https://jamanetwork.com/journals/jama/fullarticle/194154

13 Unequal Distribution of the U.S. Primary Care Workforce. Jun 01, 2013 Stephen M. Petterson, PhD; Robert L.

Phillips, Jr., MD, MSPH; Andrew W. Bazemore, MD, MPH; Gerald T. Koinis, BA. https://www.graham-center.org/rgc/publications-reports/publications/one-pagers/unequal-distribution-2013.html.

14 Bowman, RC Penrod, JD. Family practice residency program and the graduation of rural family physicians.

Family Medicine 1998;30(4):288-92. In Wisconsin Collaborative for Rural Health Care www.https://wcrgme.org/start a rural-training-track/ accessed July 17, 2019.

15Patterson, DG, Longenecker, R, Schmitz, D. Skillman, SM, Doescher, MP. Policy brief: training physicians for rural practice: capitalizing on local expertise to strengthen rural primary care. Collaboration of Rural Training Track Technical Assistance Program and WWAMI Rural Health Research Center; 2011.

16 https://www.shepscenter.unc.edu/project/diffusion-of-physicians-and-access-to-primary-care-the-role-of-person-program-and-place-2/.

https://www.ahrq.gov/ncepcr/primary-care-research/opioids.html https://patientengagementhit.com/news/telehealth-closes-patient-care-access-gaps-in-rural-mississippi https://patientengagementhit.com/news/telehealth-closes-patient-care-access-gaps-in-rural-mississippi http://depts.washington.edu/uwrhrc/uploads/RHRC_FR125_Rosenblatt.pdf http://www.shepscenter.unc.edu/download/14853/ https://jamanetwork.com/searchresults?author=Howard+K.+Rabinowitz&q=Howard+K.+Rabinowitz https://jamanetwork.com/searchresults?author=James+J.+Diamond&q=James+J.+Diamond https://jamanetwork.com/searchresults?author=Fred+W.+Markham&q=Fred+W.+Markham https://jamanetwork.com/searchresults?author=Nina+P.+Paynter&q=Nina+P.+Paynter https://jamanetwork.com/journals/jama/fullarticle/194154 https://www.graham-center.org/rgc/publications-reports/publications/one-pagers/unequal-distribution-2013.html https://www.graham-center.org/rgc/publications-reports/publications/one-pagers/unequal-distribution-2013.html http://www.https/wcrgme.org/start%20a%20rural-training-track/ https://www.shepscenter.unc.edu/project/diffusion-of-physicians-and-access-to-primary-care-the-role-of-person-program-and-place-2/ https://www.shepscenter.unc.edu/project/diffusion-of-physicians-and-access-to-primary-care-the-role-of-person-program-and-place-2/

HRSA-20-008 4

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 PCTE-RTPC Program for Fiscal Year 2020:

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.

Interprofessional, team-based care means a group of two or more health care providers from different disciplines, including direct care workers and other caregivers, who work together to meet the needs of a patient population. Work processes and interventions amongst team members 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.)

Health Professional Shortage Areas can be found using the HPSA Find Tool at https://data.hrsa.gov/tools/shortage-area/hpsa-find.

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.

Medication-Assisted Treatment (MAT) certified provider means a health care provider who uses FDA- approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.17

National Provider Identifier (NPI) – The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The NPI is a unique identification number for covered health care providers. Additional information about NPIs can be found at the following site: https://nppes.cms.hhs.gov/#/.

New Program means any means residency program that has graduated fewer than 3 consecutive classes. Creation of a new track within an existing residency program does not qualify as a new program.

Opioid Use Disorder (OUD) is a problematic pattern of opioid use leading to clinically significant impairment or distress occurring within a 12-month period.

Preceptor means an experienced practitioner who provides supervision during clinical practice and facilitates the application of theory to practice for students and staff learners.

17 Substance Abuse and Mental Health Services Administration. (n.d.). Medication-Assisted Treatment (MAT).

Retrieved May 21, 2019 from https://www.samhsa.gov/medication-assisted-treatment.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/grants/resourcecenter/glossary https://data.hrsa.gov/tools/shortage-area/hpsa-find https://data.hrsa.gov/tools/shortage-area/hpsa-find https://nppes.cms.hhs.gov/#/ https://www.samhsa.gov/medication-assisted-treatment

HRSA-20-008 5

Rural means, for purposes of this NOFO, a clinical rotation site located in an area considered rural as determined by the Federal Office of Rural Health Policy (FORHP), using the Rural Health Grants Eligibility Analyzer at https://data.hrsa.gov/tools/rural-health.

Rural Residency Programs – are allopathic and osteopathic physician residency training programs that primarily train in rural areas, place residents in rural locations for greater than 50 percent of their training, and focus on producing physicians who will practice in rural communities. A common model is the Rural Training Tracks (RTT).

Rural Track – For purposes of the NOFO, rural track means a clinical rotation(s) in a rural area required by the residency training program of varying durations.

Rural Training Tracks (RTT) – are partnerships between urban and rural clinical settings where the first year of resident training occurs within a larger program in an urban academic medical center and the final two years occur in a rural facility. For Medicare purposes, RTT programs are separately accredited rural track programs where residents rotate at rural clinical sites for more than one-half of the duration of the program.

CMS’s rules and regulations for RTT programs are available at (https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/xml/CFR-2011-title42-vol2-sec413- 79.xml).

Substance Use Disorder (SUD) means a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems.

Underserved is identified by two defined sources outlined above in Section I.1 Purpose.

II. Award Information

1. Type of Application and Award

Types of applications sought: New

HRSA will provide funding in the form of a grant.

https://data.hrsa.gov/tools/rural-health https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/xml/CFR-2011-title42-vol2-sec413-79.xml https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/xml/CFR-2011-title42-vol2-sec413-79.xml

HRSA-20-008 6

2. Summary of Funding

HRSA expects approximately $10,000,000 to be available annually to fund up to 20 recipients. You may apply for a ceiling amount of up to $500,000 total cost (includes both direct and indirect, facilities and administrative costs) per year.

The FY 2020 President’s Budget does not request funding for this program. The actual amount available will not be determined until enactment of the final FY 2020 federal appropriation. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner.

The period of performance is July 1, 2020 through June 30, 2025 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for PCTE-RTPC Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

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

III. Eligibility Information

1. Eligible Applicants

Eligible entities include accredited public or nonprofit private hospitals, schools of allopathic medicine or osteopathic medicine, or a public or private non-profit entity which the Secretary has determined is capable of carrying out a residency training program in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (“med-peds”), which for the purposes of this program are those accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Accreditation Applicants must provide documentation of accreditation by the ACGME as Attachment

10. Documentation must include (1) a statement that you hold continuing accreditation from the relevant accrediting body and are not under probation, (2) the dates of initial accreditation and next accrediting body review, (3) the accreditation start and expiration dates, and (4) a web link to the accreditation status. The full letter of accreditation is not required.

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

HRSA-20-008 7

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $500,000 per year including direct and indirect costs non-responsive and will not consider it for funding under this notice.

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Maintenance of Effort The recipient must agree to maintain expenditures of non-federal amounts for award activities at a level that is not less than the level of expenditures for such activities for the fiscal year preceding the fiscal year for which the entity receives the award, as required by Section 797(b) of the Public Health Service Act. Complete the Maintenance of Effort information and submit as Attachment 6.

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. Applications received without the information contained in Table 1 (as depicted in Table 1 in the PURPOSE and NEEDS section) will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

Resident/Faculty/Preceptor Eligibility Requirements A resident, faculty member, or preceptor receiving support from grant funds must be a citizen of the United States, a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national.

HRSA-20-008 8

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 notice of funding opportunity (NOFO) following the directions provided at http://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, clarifications and/or republications of the NOFO on Grants.gov before its closing date. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

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

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 70 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation.

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/ http://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

HRSA-20-008 9

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 the statements in this certification, an explanation shall be included in Attachment 11: 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

Program Requirements

1. Plan, develop and operate a program for the training of residents to practice as primary care physicians in rural and/or underserved areas. This may include development or enhancement of a new training track and/or clinical rotation(s) in rural and/or underserved areas.

2. Demonstrate an ability to recruit and place residents in clinical training sites that provide, interprofessional, team-based care in rural and/ or underserved areas.

3. Develop recruitment and retention strategies which may include, as applicable, targeting medical students from the Medical Student Education (MSE) Program and Primary Care Training and Enhancement (PCTE) Programs that address training of medical students to your residency program. Awardees of MSE and PCTE programs can be found at the https://www.data.hrsa.gov.

4. Provide each resident in the program with dedicated clinical experiences with at least one provider with a DATA-2000 waiver who provides Medication- Assisted Treatment (MAT) services for patients with OUD.

5. Develop a plan to collect post-graduation employment demographics with graduates from residency training programs for at least five (5) years after they complete their residency. Award recipients must require residents to apply for a National Provider Identifier (NPI) number and collect the NPI numbers of residents who receive stipends/traineeship funds. NPI numbers are used by HRSA to track the residents and graduates to determine achievement in meeting program objectives.

6. Provide longitudinal clinical training experience in rural and/or underserved areas for three months or longer.

7. Develop linkages/partnerships with relevant educational and health care entities including private sector and safety net providers including official public health departments to improve access to and quality of care in rural and/or underserved areas and with clinical ambulatory sites to provide longitudinal and interprofessional learning experiences for residents.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=465cc41b-d985-42a4-b56d-e85b0c12864a https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=465cc41b-d985-42a4-b56d-e85b0c12864a https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=38276321-01fa-4e95-87b8-98d82921312e https://www.data.hrsa.gov/ https://npiregistry.cms.hhs.gov/

HRSA-20-008 10

8. Provide dedicated clinical experiences to residents in the use of telehealth technology to improve access to health services and improve patient outcomes.

9. Provide information to residents throughout their training program about the National Health Service Corps (NHSC) programs, particularly the Loan Repayment Program, as well as the Indian Health Service (IHS) Loan Repayment Program, and provide guidance and resources to help them locate employment in NHSC approved sites after they graduate.

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

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

The Abstract must include:

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

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

3. Which of the clinical priorities will be addressed by the project, if applicable;

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

5. Statement on if the applicant is applying for a funding preference.

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

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. The Project Narrative should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project. It must address the goals and purpose of the NOFO and the strategies to be used in attaining the goals and meeting the funding opportunity’s purpose.

Successful applications will provide 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 areas that trainees would ultimately serve.

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

1. Shortages and need for additional primary care physicians in the state in which the residency program is located, especially in its rural and/ or underserved areas, and the impact on this need to the areas that your residency program is working to solve. To the extent possible, include data on the demographics, social determinants of health/health disparities faced by, and health care https://nhsc.hrsa.gov/ https://nhsc.hrsa.gov/loan-repayment/index.html https://nhsc.hrsa.gov/loan-repayment/index.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

HRSA-20-008 11

needs of the population served, with a focus on rural and/or underserved areas.

2. Gaps in your residency training program related to telehealth, and the prevention and treatment of opioid and other substance use disorders that will be addressed if the program receives funding through this HRSA program.

3. Need for development or enhancement of a rural and/or underserved track and/or rotation(s) in the areas served by this residency program.

4. Characteristics of existing residency program partners that align with the purposes of this project and need for strengthening of academic and community linkages/partnerships with private sector and safety net providers for development of clinical training sites for residents, preceptor development and retention, and well-trained, culturally competent primary care providers;

5. Longitudinal clinical training experience in rural and/or underserved areas for three months or longer.

6. Number of graduates from AY 17-18 and AY 18-19 that practice primary care in a primary care setting following completion of residency and number of residents from AY 17-18 and AY 18-19 that go on to subspecialty fellowships and type of fellowships depicted in Attachment 4;

7. Clinical training site(s) where the residents will train and include the following information depicted in the Table 1 example as Attachment 5.

Table 1

Clinical Trainin g Site Name

Clinical Train ing Site Addr ess

(EXAMPL

E:

XX

Main Stree t, Tow n, State Exte nded Zip code

Number of Reside nts by specialt y, who will be involve d in grant activitie s

Interdiscip linary team-based care setting (Yes/No)

Number of trainee hours and weeks/mo nths at training site

Clinical training site offers

MAT

and

OUD

preventi on and treatme nt services (Yes/No

Clinica l trainin g site offers telehe alth servic es (Yes/N o)

Does state in which clinical training site is located have a projected shortage of primary care providers in 2025, using the

NCHWA

shortage projections for primary care shortage for

FY2025

(Yes/No)

Clinical training site is located in an area considered rural as determined by the Federal Office of Rural Health Policy (FORHP),using the Rural Health Grants Eligibility Analyzer (Yes/No)

1.

2.

HRSA-20-008 12

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).

In this section, you must provide a comprehensive, detailed work plan that addresses how, through concrete steps, you plan to implement the proposed project in order to achieve the goals of the NOFO and successfully implement the proposed activities identified in the Methodology/Approach section. The work plan must align with and drive the methodology and include the following:

1. Description of the activities or steps, key partners, staff responsible, and timeframes during the five (5) year period of performance. Goals and objectives must be specific, measurable, achievable, realistic, and time framed;

2. Explanation of how the work plan is appropriate for the program design and how the targets for key activities fit into the overall grant implementation timeline and five (5) year period of performance;

3. 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 areas served;

4. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly used and monitored, including having policies and procedures in place that meet or exceed the requirements in 45 CFR part 75 regarding sub-recipient monitoring and management;

5. Description of 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; and

6. Describe how the program will provide information to residents throughout their program about the NHSC programs, especially the loan repayment program and provide guidance and resources to help their residents and graduates locate employment in NHSC approved sites and HPSAs after they graduate.

A sample work plan can be found here:

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

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

In this section, you must describe how you will prepare residents to practice primary care in rural and/or underserved areas. You must also describe your objectives, proposed activities, and strategies, and provide evidence for how your program provides health care services, including telehealth, in settings that provide interdisciplinary, team-based care in rural and/or underserved areas. You must also describe your objectives, proposed activities, and strategies, and provide evidence for how they (1) align with and http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

HRSA-20-008 13

drive the work plan, (2) incorporate each of the program goals and objectives and expectations of the NOFO; and (3) address the needs in the Purpose and Need section.

You must present the methodologies, strategies, and approaches for steps your program intends to undertake were it to receive a HRSA award through this funding opportunity – including for the following specific activities:

1. Develop and operate a program for the training of medical residents to practice as primary care physicians to provide care in rural and/or underserved areas. This may include development or enhancement of a new training track and/or clinical rotation(s) in rural and/or underserved areas.

2. Demonstrate an ability to recruit and place residents in clinical training sites that provide interprofessional, team-based care in rural and/or underserved areas.

3. Develop recruitment and retention strategies. These may include, as applicable, targeting medical students from the Medical Student Education (MSE) Program and Primary Care Training and Enhancement (PCTE) Programs that address training of medical students to your residency program serving rural and underserved areas. Awardees of MSE and PCTE programs can be found at the https://www.data.hrsa.gov HRSA website.

4. Provide each resident in the program with dedicated clinical experiences with at least one provider with a DATA-2000 waiver who provides Medication- Assisted Treatment (MAT) services for patients with OUD.

5. Develop a plan to collect post-graduation employment demographics with graduates from residency training programs for at least five (5) years after they complete their residency. Award recipients must require residents to apply for a National Provider Identifier (NPI) number and collect the NPI numbers of residents who receive stipends/traineeship funds. NPI numbers are used by HRSA to track the residents and graduates to determine achievement in meeting program objectives.

6. Provide longitudinal clinical training experience in rural and/or underserved areas for three months or longer.

7. Provide dedicated clinical experiences to residents in the use of telehealth technology to improve access to health services and improved patient outcomes.

8. Develop linkages/partnerships with private sector and safety net providers, including official public health departments, to improve access to and quality of care in rural and/or underserved areas, and with clinical ambulatory sites to provide longitudinal interprofessional learning experiences.

9. Provide information to residents throughout their training program about the National Health Service Corps (NHSC) programs, particularly the Loan Repayment Program, as well as the Indian Health Service (IHS) Loan Repayment Program, and provide guidance and resources to help them locate employment in NHSC approved sites and other sites located in HPSAs after they graduate.

10. Develop a logic model for designing and managing the project as Attachment 8. 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 https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=465cc41b-d985-42a4-b56d-e85b0c12864a https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=465cc41b-d985-42a4-b56d-e85b0c12864a https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=38276321-01fa-4e95-87b8-98d82921312e https://bhw.hrsa.gov/fundingopportunities/default.aspx?id=38276321-01fa-4e95-87b8-98d82921312e https://www.data.hrsa.gov/ https://npiregistry.cms.hhs.gov/ https://nhsc.hrsa.gov/ https://nhsc.hrsa.gov/loan-repayment/index.html https://nhsc.hrsa.gov/loan-repayment/index.html

HRSA-20-008 14

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, reasons for proposing the intervention);

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

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

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

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

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

and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

You can find additional information on developing logic models at the following website: https://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (c)

In this section, you must discuss challenges that you anticipate encountering in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges. This section should include:

1. Challenges related to program goals and objectives, work plan, project implementation, and achievement of the proposed goals and objectives (e.g., program performance evaluation and performance measurement requirements);

2. Challenges to ensuring that longitudinal clinical experiences support the stated curriculum;

3. Challenges related to workforce development, such as recruitment of residents to the PCTE-RTPC program and recruitment and retention of preceptors in rural and/or underserved areas;

4. Obstacles to obtaining clinical training sites that offer telehealth and MAT;

5. Resources and plans to resolve and overcome these challenges and obstacles, and examples of such; and

6. General Challenges related to residents training in rural and/or underserved areas as defined by this NOFO.

https://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf

HRSA-20-008 15

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a)

In this section, you must describe your plan for program performance evaluation. A comprehensive evaluation will yield outcome data that both you and HRSA can use throughout the project to ensure the success of the project.

Program Performance Evaluation: You must provide a Performance Evaluation Plan that will contribute to continuous quality improvement. The plan must include:

1. How you will monitor ongoing processes and progress toward meeting goals and objectives of the project;

2. Descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, budget, and other resources), key processes and variables to be measured;

3. Expected outcomes of the funded activities;

4. Data on current practice location of graduates and their relationship to the location of the residency’s clinical training sites.

5. Description of how all key evaluative measures will be reported and disseminated;

6. The plan for program performance evaluation. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, budget, and other resources); key processes; evaluation questions; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported; and

7. Description of the feasibility and effectiveness of plans for replicability of the residency program and dissemination of project results.

In the Attachments section (IV. 2. v. Attachment, 1), you must attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form. 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.

We encourage applicants to include a plan for evaluating and reporting on graduate outcomes of their residency programs, including post-graduate data for residents who have completed their training at your program; and any improvements in patient access, quality of care, and cost effectiveness, and provider wellness, achieved as a result of your program. You are encouraged to align your outcome measures with existing HRSA performance measures (https://bhw.hrsa.gov/sites/default/files/bhw/grants/performancemeasures/Primary_Care_ Training_Enhancement_Program_PTCE.docx), and report outcome and impact findings through public reports, presentations, and/or publications.

HRSA-20-008 16

Document the procedure for assuring the data collection, management, storage, and reporting of NPI…