PKG00256889-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Addiction Medicine Fellowship Program

Funding Opportunity Number: HRSA-20-013

Funding Opportunity Type: New

Assistance Listings (CFDA) Number: 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Letter of Intent Requested by: January 6, 2020

Application Due Date: February 25, 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: November 27, 2019

Miryam C. Gerdine, MPH Social Science Research Analyst/Project Officer Behavioral and Public Health Branch, Division of Nursing and Public Health Email: AMF@hrsa.gov

Authority: Section 760(a)(1) of the Public Health Service Act (42 U.S.C. § 294k(a)(1)) mailto:AMF@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Addiction Medicine Fellowship (AMF) Program.

The purpose of the AMF Program is to expand the number of fellows at accredited AMF and Addiction Psychiatry Fellowship (APF) programs trained as addiction medicine specialists who work in underserved, community-based settings that integrate primary care with mental health disorders and substance use disorder (SUD) prevention and treatment services. The AMF Program encompasses both psychiatry and an addiction subspecialty for primary care doctors.

Funding Opportunity Title: Addiction Medicine Fellowship Program

Funding Opportunity Number: HRSA-20-013 Due Date for Applications: February 25, 2020 Anticipated Total Annual Available FY 2020 Funding:

$20,000,000

Estimated Number and Type of Award(s): Approximately 25 grants Estimated Award Amount: Up to $800,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: Match is only required where applicable, to cover any fellows’ stipend costs beyond $100,000 per geographic reimbursement requirements set by the applicable educational institution or association.

Period of Performance: July 1, 2020 through June 30, 2025 (5 years)

Eligible Applicants: Eligible applicants include sponsoring institutions of accredited addiction medicine fellowship programs or accredited addiction psychiatry fellowship programs, or a consortium consisting of at least one teaching health center and one sponsoring institution of an addiction medicine or addiction psychiatry fellowship program.

If an entity applies as part of a Consortium, the entity is not eligible to submit a separate, stand-alone application.

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

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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

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

3. SUBMISSION DATES AND TIMES

4. INTERGOVERNMENTAL REVIEW

5. FUNDING RESTRICTIONS

6. OTHER SUBMISSION REQUIREMENTS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

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

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Addiction Medicine Fellowship (AMF) Program.

Program Purpose The purpose of the AMF Program is to expand the number of fellows at accredited AMF and Addiction Psychiatry Fellowship (APF) programs trained as addiction medicine specialists who work in underserved, community-based settings that integrate primary care with mental health disorder and substance use disorder (SUD) prevention and treatment services. The Addiction Medicine Program encompasses both psychiatry and an addiction subspecialty for primary care doctors.

Program Goals The AMF Program is designed to foster robust community-based clinical training of addiction medicine or addiction psychiatry physicians who see patients at various access points of care and provide addiction prevention, treatment, and recovery services across healthcare sectors.

Program Objectives

• Increase the number of board certified addiction medicine or addiction psychiatry sub-specialists produced per program annually by providing stipends for new addiction medicine or addiction psychiatry fellowship slots and additional program support to sponsoring institutions.

• Collaborate and establish formal relationships with underserved, community-based settings (such as HRSA-supported health centers,1 integrated behavioral health community health centers, Medication Assisted Treatment (MAT) facilities, and affiliated evidence-based substance use treatment centers) to provide training of AMF Program fellows at these sites.

• Develop or enhance training for faculty from collaborating programs to create an infrastructure of skills and expertise that supports training fellows to provide opioid use disorder (OUD) and other SUD prevention, treatment and recovery services on integrated, interprofessional teams.

1 https://www.findahealthcenter.hrsa.gov/ Health centers are defined in section 330 of the Public Health Service Act on page 237 at https://legcounsel.house.gov/Comps/PHSA-merged.pdf https://www.findahealthcenter.hrsa.gov/ https://legcounsel.house.gov/Comps/PHSA-merged.pdf

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HHS and HRSA Priorities This program will build upon HRSA’s existing OUD and other SUD investments and support the U.S. Department of Health and Human Services (HHS) initiative to combat the opioid crisis. It is expected that you address the first two priorities below and, if applicable, the third:

• Combatting the opioid crisis/Mental Health disorders

• Transforming the workforce –targeting the need

• Expanding telehealth services

2. Background

This Program is authorized by Section 760(a)(1) of the Public Health Service Act (42 U.S.C. § 294k(a)(1)). According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health, 19.3 million people aged 18 or older had a substance use disorder in 2018.2 The Centers for Disease Control and Prevention (CDC) estimates that 72,000 Americans died from drug overdose in 2017,3 and on average 115 Americans die of an opioid overdose every day.4 In addition, it is estimated that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.5

Over the past several decades, there has been an expanding awareness of the importance of substance use education for medical students, residents, and practicing physicians. The greater emphasis on SUD training corresponds with a wider perception of SUDs as chronic medical conditions that has led in part to the development of SUD fellowships.6 Potentially as a result of this, the quantity and quality of medical education on SUDs has improved.7

Addiction Psychiatry is an official subspecialty of general psychiatry. The American Board of Psychiatry and Neurology, Inc. (ABPN) created the certification for Addiction Psychiatry in 1993. The ABPN is one of 24 member boards of the American Board of Medical Specialties (ABMS). ABPN offers certification in the subspecialty of Addiction Psychiatry to physicians who have completed accredited residency programs in general psychiatry. Addiction Psychiatry offers specialized training in the evaluation and management of individuals with substance use and co-occurring mental health

2 Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ 3 Center for Disease Control and Prevention. (n.d.). Drug Overdose Deaths. Retrieved January 9, 2019, from https://www.cdc.gov/drugoverdose/data/statedeaths.html 4 National Institute on Drug Abuse. (2018, March). Opioid Overdose Crisis. Retrieved January 9, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.

5 Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United

States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.

6 Galanter M, Kaufmen E, Schnoll S, Burns J. Postgraduate medical fellowship training in alcoholism and drug abuse: national consensus standards. Am J Drug Alcohol Abuse. 1991;17:1–12.

7 Fleming M, Barry K, Davis A, et al. Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992. Acad Med. 1994;69:362–369.

https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html https://www.samhsa.gov/data/ https://www.cdc.gov/drugoverdose/data/statedeaths.html https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

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disorders.8 Addiction psychiatrists see patients with all substance use disorders including alcohol, tobacco, cocaine, methamphetamine, benzodiazepines, opioids, cannabis, and designer drugs, often with other co-occurring mental health illnesses.

Some addiction psychiatrists work primarily with individuals with behavioral addictions.

In 2018, among the 19.3 million adults with a past year SUD, 9.2 million (47.7 percent) also had a mental illness in the past year9. Given the co-occurrence of mental health and substance use disorders, addiction psychiatrists are included in the AMF Program to build provider capacity to respond to the needs of the patient.

In 2015, the American Board of Medical Specialties (ABMS) officially recognized Addiction Medicine as a subspecialty. Despite these improvements in addiction training and care, the overall emphasis on SUDs varies across the medical academic continuum, and training on addiction care remains disproportionately low compared with other chronic medical disorders.10,11,12,13,14

There are approximately 70 accredited AMF programs nationwide, most of which are accredited by the Accreditation Council for Graduate Medical Education (ACGME), with the others being accredited by the American College of Academic Addiction Medicine (ACAAM). By 2021, all eligible AMF programs will solely be accredited by the ACGME.

These programs are typically 12 months in duration and produce an average of 2 fellows per year, who are program graduates as board eligible Addiction Medicine Specialists, with the ability to provide medication assisted treatment.

The newly developed AMF Program aims to increase the number of board certified addiction medicine and addiction psychiatry sub-specialists serving in underserved, community-based settings over the 5-year period of performance by providing stipends for new AMF and APF slots and additional program support to sponsoring institutions.

The need for physicians with expertise and skills to provide OUD and other SUD prevention, treatment and recovery services is evident. Expanding the addiction medicine workforce can be expected to increase access to evidence-based prevention services, reduce the prevalence of SUD, and increase access to evidence-based treatment and recovery services.

You are encouraged to partner with HRSA-supported health centers to recruit physicians currently working in these health centers to become AMFs or APFs as well

8 Nihit Kumar, MD, of the University of Arkansas for Medical Sciences Supported by the AADPRT Recruitment Committee, August 2018;

https://www.aadprt.org/application/files/1315/3624/6506/ADDICTION_PSYCHIATRY_FELLOWSHIP_HOW_AND_WHY_TO_APPL Y.pdf retrieved September 30, 2019.

9Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ 10Klamen DL. Education and training in addictive diseases. Psychiatr Clin North Am. 1999;22:471–480.

11 Isaacson JH, Fleming M, Kraus M, et al. A national survey of training in substance use disorders in residency programs. J Stud

Alcohol. 2000;61:912–915.

12 Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools.

JAMA. 2002;288:1102–1109.

13 Powers CA, Zapka JG, Bognar B, et al. Evaluation of current tobacco curriculum at 12 US medical schools. J Cancer Educ.

2004;19:212–219.

14 Prochaska JJ, Fromont SC, Louie AK, et al. Training in tobacco treatments in psychiatry: a national survey of psychiatry residency training directors. Acad Psychiatry. 2006;30:372–378.

https://www.aadprt.org/application/files/1315/3624/6506/ADDICTION_PSYCHIATRY_FELLOWSHIP_HOW_AND_WHY_TO_APPLY.pdf%20retrieved%20September%2030 https://www.aadprt.org/application/files/1315/3624/6506/ADDICTION_PSYCHIATRY_FELLOWSHIP_HOW_AND_WHY_TO_APPLY.pdf%20retrieved%20September%2030 https://www.samhsa.gov/data/

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as to provide experiential training to these fellows. HRSA-supported health centers have significantly increased the number of providers working in interprofessional teams to provide primary care and mental health services, including OUD and other SUDs.

There are nearly 1,400 HRSA-supported health centers operating across the United States. To find the location of the closest health center, utilize the locator tool (https://www.findahealthcenter.hrsa.gov/).

In addition, the Program aims to support fellows working in National Health Service Corps (NHSC) sites upon their graduation. The NHSC is committed to strengthening the primary care workforce through the recruitment and retention of high quality primary care providers at NHSC-approved sites. The NHSC Loan Repayment Program (LRP) provides loan repayment assistance to primary health care professionals in exchange for a commitment to serve in a Health Professional Shortage Area (HPSA). The NHSC plans to provide physicians who have completed a HRSA-funded AMF or APF program with priority status when applying for NHSC LRP awards. Details concerning the priority status for physicians who have completed the AMF Program will be announced in NHSC Application and Program Guidance (APG) beginning the first competitive cycle following the award of the grants or subsequent appropriate APG.

HRSA has a number of investments targeting OUD and other SUDs across its bureaus and offices that applicants may be able to leverage. For information on HRSA-supported resources, technical assistance, and training, visit here:

https://www.hrsa.gov/opioids.

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, a listing of other key terms that apply to the AMF Program can be found in the “Other Information” section (Section VIII).

II. 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 $20,000,000 to be available annually to fund 25 award recipients. You may apply for a ceiling amount of up to $800,000, total cost (includes both direct and indirect, facilities and administrative costs) per year. 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 https://www.findahealthcenter.hrsa.gov/ https://www.hrsa.gov/opioids https://bhw.hrsa.gov/grants/resourcecenter/glossary

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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 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.

Limitations on indirect cost rates 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 applicants include U.S. based sponsoring institutions of accredited addiction medicine or accredited addiction psychiatry fellowship programs, or a consortium consisting of at least one domestic teaching health center and one domestic addiction medicine or addiction psychiatry fellowship program.

The sponsoring institution of addiction medicine or addiction psychiatry fellowship programs must be accredited by ACGME or, until 2021, by ACAAM. Programs accredited by the ACAAM must demonstrate their ability to become ACGME accredited by 2021, when all program graduates must be from ACGME-accredited programs in order to be eligible for board certification. ACAAM-accredited programs not actively seeking ACGME accreditation will not be eligible for the AMF Program after 2021 as program graduates from ACAAM-accredited programs will not be eligible for addiction medicine certification through the American Board of Preventive Medicine (ABPM), a member board of the American Board of Medical Specialties (ABMS).

2. Cost Sharing/Matching

Match is only required, where applicable, to cover any fellows stipend costs beyond $100,000 per geographic reimbursement requirements set by the applicable educational institution or association.

The minimum stipend amounts that can be charged to the award are fixed. Award recipients may not provide stipends lower than the amounts specified above ($100,000);

however, award recipients may choose to provide higher stipend amounts by including funds from other non-federal sources, who must be identified in the application. Total http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

3. Other

Verification of Accredited Board Certified AMF or APF Program Section IV of this NOFO requires that applicants applying for the AMF Program must provide documentation of their institution’s AMF or APF accreditation to support eligibility, specifying the dates covered by the active accreditation, including expiration date, as Attachment 10.

All applicants must provide proof of accreditation. HRSA may consider any application that fails to attach a copy of the required accreditation or certification documentation non-responsive, and may not consider it for funding under this notice. Applicants are required to maintain their accreditation throughout the period of performance and notify HRSA of change in status. Failure to maintain accreditation status may result in the termination of grant funding.

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $800,000 per year 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 non-federal funding for award activities at a level that is not less than expenditures for such activities during the fiscal year prior to the fiscal year for which the recipient receives the award, as required by PHS Act section 797(b). Complete the Maintenance of Effort information and submit as Attachment 5.

Multiple Applications Multiple applications from an organization are not allowed. If an entity applies as part of a Consortium, the entity is not eligible to submit a separate, stand-alone application. An organization is the sponsoring institution of accredited addiction medicine fellowship program that has a unique DUNS numbers.

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

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

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Trainee Eligibility Fellows must be enrolled full or part-time in the sponsoring institution receiving the grant award in order to receive stipend support in HRSA’s AMF Program. A fellow receiving support from grant 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. Individuals on temporary or student visas are not eligible to receive stipend support.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this NOFO following the directions provided at 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 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.

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.

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

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Application Page Limit The total size of all uploaded files may not exceed the equivalent of 60 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.

Proof of non-profit status (if applicable) does not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified 60 page limit.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) 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 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. Project Title;

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

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

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

5. 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;

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6. Statement indicating eligibility for funding priority and funding preference (if applicable).

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

ii. Project Narrative

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

The section of the Public Health Service Act authorizing this Program, 760(b)(1)(A)(ii), discusses three different types of training tracks and states that grant recipients must provide at least one: “(I) a virtual training track that includes an in-person rotation at a teaching health center or in a community-based setting, followed by a virtual rotation in which the resident or fellow continues to support the care of patients at the teaching health center or in the community-based setting through the use of health information technology and, as appropriate, telehealth services; (II) an in-person training track that includes a rotation, during which the resident or fellow practices at a teaching health center or in a community-based setting; or (III) an in-person training track that includes a rotation during which the resident practices in a community-based setting that specializes in the treatment of infants, children, adolescents, or pregnant or postpartum women.”

o If you choose to implement a virtual training track, provide a final program objective to establish or expand the use of innovative telehealth technology in the treatment of OUD and other SUDs to improve access to health services and patient outcomes.

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

Describe the purpose and need for the proposed project, including:

• The needs of the physician workforce in the local community, including the training site’s patient population, and a description of the expertise and training that the staff of your program will provide to address these needs;

• The OUD and other SUD prevention, treatment, and recovery needs of the community where fellows will train;

• The needs of your training program, how many fellowship applications your program receives, how many that could otherwise have been accepted are turned down due to lack of funding;

• Descriptions of the faculty on staff;

• The training needs for faculty to maintain and/ or develop an infrastructure of skills and expertise, that will support their ability to train fellows to provide OUD

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and other SUD prevention, treatment and recovery services on integrated, interprofessional teams;

• Utilization of at least one of the three different types of training tracks: (I) a virtual training track that includes an in-person rotation at a teaching health center or in a community-based setting, followed by a virtual rotation in which the fellow continues to support the care of patients at the teaching health center or in the community-based setting through the use of health information technology and, if applicable, telehealth services, (II) an in-person training track that includes a rotation, during which the fellow practices at a teaching health center or in a community-based setting; or (III) an in-person training track that includes a rotation during which the fellow practices in a community-based setting that specializes in the treatment of infants, children, adolescents, or pregnant or postpartum women. Include the information shown in Table 1 in Attachment 4;

• Identification of gaps and barriers in preparing fellows to provide integrated team-based care with two or more health disciplines with a focus on OUD and other SUDs and at-risk populations; and

• Identification of the benefit to the community from the academic and community partnerships in the proposed project.

Table 1

Site Name Number of Proposed Additional Fellows funded by HRSA

Number of Physicians hours in rotation

Number of fellows to be trained in each training track

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).

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.):

1. 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.

2. Describe the timeframes, deliverables, and key partners required during the grant period of performance to address each of the needs described in the Purpose and Need section. Include the number of addiction medicine or addiction psychiatry fellows your program trains now, and the number of additional fellows your program would train if funded.

3. Describe the activities and timeframe for faculty development and how these activities address the needs described in the Purpose and Need section.

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

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4. Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation.

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

6. Describe any plans to leverage health care facilities in community-based settings (such as HRSA-supported health centers and/or other community-based settings that integrate primary care with mental health and substance use disorders prevention and treatment services), to support your proposed project and fellows.

7. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly used. Make a statement that you understand your organization must have policies and procedures in place that meet or exceed the requirements in 45 CFR part 75 regarding sub-awards, consortiums and contracts and sub-recipient monitoring.

8. Describe your process to track trainees after program completion/graduation for up to five years to assess career choices. At a minimum this must include tracking trainees’ National Provider Identifier (NPI).

9. Maximize the completion rate of addiction medicine or addiction psychiatry fellows by prioritizing full time programming.

The work plan must be submitted as Attachment 6.

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

#2 (b).

You must describe how you will expand the number of addiction medicine or addiction psychiatry fellows as well as prepare the fellows to provide OUD and other SUD prevention, treatment, and recovery services, in community-based settings that provide integrated, interprofessional team-based care services. Also describe your objectives, proposed activities, and strategies, and provide evidence for how they (1) align with and drive the work plan, (2) incorporate each of the program goals and objectives; and (3) address the needs highlighted in the Purpose and Need section. Explain why your project is innovative and provide the context for why your project is innovative.

Present a clear plan to:

• Recruit and train additional fellows beyond existing baseline levels of approved positions to increase the number of board certified addiction medicine or addiction psychiatry sub-specialists who are trained in providing integrated, interprofessional team-based care for the purposes of prevention, treatment, and recovery services for OUD and other SUD within underserved, community-based settings;

• Identify the additional number of fellows and faculty that will be trained in the AMF program;

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• Deliver experiential training that models and develops competencies in integrated, interprofessional team-based care focusing on at-risk populations for OUD and other SUD prevention, treatment and recovery services;

• Assist fellows upon program completion to obtain employment in facilities located in underserved, community-based settings;

• Provide faculty development to create an infrastructure of knowledge, skills and expertise in support of integrated, interprofessional team-based care teams;

• Maintain appropriate accreditation status for the AMF or APF program;

• Collaborate and establish formal relationships with underserved, community-based settings (such as HRSA-supported health centers, integrated behavioral health community health centers, Medication Assisted Treatment facilities, and affiliated detoxification units) to provide training of AMF or APF program fellows at these sites;

• Grant recipients are required to have all fellows obtain NPI numbers to aid long-term assessment of the Program’s impact on access and delivery of quality behavioral health care services. Fellows who receive HRSA funds as a result of this award must apply for an NPI for the purpose of collecting post-completion employment demographics, and grant recipients are required to report the NPI numbers for all individuals participating in the Program to HRSA. Provide a clear plan for how you will have fellows obtain NPI numbers to aid in the collection of post completion employment demographics;

• If applicable, provide training for fellows to practice via telehealth with well-reasoned estimates of the number of patients that will receive care for each service during each year of the grant; and

• Demonstrate a holistic approach to health care that incorporates the social determinants of health.

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

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

• 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 personnel, budget, other resources);

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

• 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).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan

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provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. 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 Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches to resolve such challenges.

This section must include:

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

2. Challenges related to the workforce development, such as recruitment and retention, and education and training of fellows and faculty;

3. Obstacles to obtaining placements in experiential training sites in underserved, community based settings that integrate primary care with mental health and substance use disorders prevention and treatment services, and hiring faculty with the principal focus on Addiction Medicine or Addiction Psychiatry; and

4. Resources and plans to resolve and overcome these challenges and obstacles.

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)

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

The plan must include:

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

2. An approach for utilizing both quantitative and qualitative data efforts to periodically review program outcomes;

3. 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;

4. Expected outcomes of the funded activities; and

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

Submit as Attachment 1 a complete staffing plan and job descriptions for key personnel.

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

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Bio sketches of key personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form. 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.

Performance Reporting Plan: HRSA will produce an annual report based on the data submitted. Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. The following link includes examples of the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html.

Describe the data collection strategy to collect, manage, analyze and track data to measure the impact/outcomes of the work plan in a way that allows for accurate and timely reporting of performance outcomes.

Describe potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

Describe your process to track fellows after program completion/graduation for up to five years, to include collection of fellows’ National Provider Identifiers (NPI). (Note:

fellows who receive HRSA funds as a result of this award must apply for an NPI for the purpose of collecting post-graduation employment demographics). You must collect the NPI numbers of fellows who receive HRSA funds.

Following are the required data measures. Describe your capacity to collect, validate, and report these data:

• Total number of addiction medicine or addiction psychiatry fellows to whom your program has provided support for experiential training via this grant;

• Total number of eligible applicants that applied to your addiction medicine or addiction psychiatry fellowship program and the number you were unable to enroll due to lack of funding;

• Total number of implemented integrated, interprofessional trainings developed by your organization;

• Number of fellows trained in addiction medicine or addiction psychiatry per year:

Number trained via full time program Number trained via part time program

• Data concerning fellows such as: demographics of fellows trained, number who complete training during the period of performance, and number of program graduates who pursue employment working in primary care, rural or underserved communities;

• Employment settings of program graduates (e.g., HRSA-supported community health centers, hospitals, community mental health clinics, academic institutions, etc.) in underserved, community-based settings;

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

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• Number of hours fellows trained in rotations working with patients with or at-risk of developing OUD and other SUD;

• Number of staff who received faculty development in addiction medicine or addiction psychiatry via this grant;

• If applicable, number of rotations offering telehealth, and

• If applicable, number of encounters for OUD and other SUD prevention, treatment, and recovery services utilizing telehealth.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b) Provide a clear plan for project sustainability after the period of federal funding ends.

The sustainability plan must include:

(a) Description of specific actions you will take to highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in training and improving OUD and other SUD prevention, treatment and recovery services;

(b) Description of actions to maintain relationships between academic institutions, experiential training sites and other interprofessional partners, including behavioral health organizations, community-based organizations, and non-traditional community organizations that integrate primary care with mental health and SUDs prevention and treatment services;

(c) Proposed actions to obtain future sources of potential funding, specifically for maintaining the additional training slots created through this program;

(d) Timetable for becoming self-sufficient. Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population; and

(e) Discussion of challenges that are likely to be encountered in sustaining the program, and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

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

1. Information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to expand the number of AMF and APF fellows supported as well as other AMF Program goals and objectives;

2. A project organizational chart as Attachment 3. Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings;

3. Evidence of the capacity to provide didactic and experiential training and supervision to both baseline number and HRSA-AMF supported fellows;

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4. Evidence of an adequate staffing plan as Attachment 1 and project organizational chart as Attachment 3; and

5. Evidence of institutional support, e.g., letters of agreement and support and resource (commitment to provide financial or in-kind resources, including institutional policy) provided in Attachment 9.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 1 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile (Expanded) form, which can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

Biographical sketches, not exceeding two pages per person, should include the following information:

• Senior/key personnel name

• Position Title

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

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

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly…