PKG00257235-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce

Division of Nursing and Public Health

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: March 6, 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: December 20, 2019

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

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

Nurse Anesthetist Traineeship (NAT) Program

Funding Opportunity Number: HRSA-20-007

Funding Opportunity Type: New, Competing Continuation

Assistance Listings (CFDA) Number: 93.124 mailto:KBreeden@HRSA.gov mailto:MMcCalla@HRSA.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 the Nurse Anesthetist Traineeship (NAT) Program. The purpose of this program is to support eligible entities to meet the cost of traineeships for individuals (full-time only) in nurse anesthesia degree programs. Grants are awarded to accredited institutions that educate registered nurses to become nurse anesthetists; recipient institutions, in turn, disburse funds to students in the form of traineeship support. The aim is to increase the number of Certified Registered Nurse Anesthetists nationally who are well prepared and well-positioned to practice independently and deliver evidence-based, high quality, and safe anesthesia and services related to the management and treatment of acute and chronic pain. NAT students may use traineeship funds during the period for which the traineeship is provided for full or partial costs of the tuition and fees, books/e-books, and reasonable living expenses (stipends). The funds appropriated for the NAT Program are distributed among all eligible applicant institutions based on a formula.

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: Nurse Anesthetist Traineeship Program Funding Opportunity Number: HRSA-20-007 Due Date for Applications: March 6, 2020 Anticipated Total Annual Available FY 2020 Funding:

$2,250,000

Estimated Number and Type of Award(s): Up to 80 grants annually Estimated Award Amount: Award amount determined by formula.

Cost Sharing/Match Required: No Period of Performance: July 1, 2020 – June 30, 2023 (3 Years) Eligible Applicants: Eligible applicants are schools of nursing, nursing centers, academic health centers, state or local governments, and other public or private nonprofit entities determined appropriate by the Secretary.

See Section III-1 of this Notice of Funding Opportunity (NOFO) for complete eligibility information.

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

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

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

vi. Attachments

3. DUN AND BRADSTREET UNIVERSAL NUMBERING SYSTEM (DUNS) AND SYSTEM FOR AWARD

MANAGEMENT

4. SUBMISSION DATES AND TIMES APPLICATION

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

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Nurse Anesthetist Traineeship (NAT) Program. The purpose of the Nurse Anesthetist Traineeship Program is to increase the number of Certified Registered Nurse Anesthetists (CRNAs) providing care, especially to rural and underserved populations.

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

Program Objectives To achieve the Program Purpose and Program Goals, accredited Nurse Anesthesia Programs will educate eligible beneficiaries (students-trainees who are Registered Nurses) to graduate and become CRNAs. Awarded institutions disburse funds to eligible beneficiaries (students-trainees) in the form of traineeship support (full or partial costs of the tuition and fees, any required books/e-books, and stipends for reasonable living expenses) based on a formula.

HHS and HRSA Priorities You are encouraged to select and address at least one of the HHS and HRSA clinical priorities below as applicable:

• Combatting the opioid crisis* / Improving Mental Health

• Value-based care delivery and quality improvement initiatives

• Transforming the workforce – targeting the need

• Telehealth

• Childhood Obesity

• Maternal Mortality

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2. Background

This program is authorized by Title VIII, Section 811(a)(2) of the Public Health Service Act, 42 U.S.C. § 296j(a)(2). The NAT program aims to increase the number of Certified Registered Nurse Anesthetists (CRNAs) who are well prepared and well positioned to practice independently and collaboratively within interprofessional teams and to deliver evidence-based, high quality, and safe anesthesia and pain management services.

Anesthesia and pain management services are part of the continuum of anesthesia care for surgical procedures that includes the management and treatment of acute and chronic pain. CRNAs are the primary providers of anesthesia care in rural America and, in some instances, may be the sole provider of anesthesia services.1 According to the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA), there are almost 54,000 CRNAs in the United States working in every health care setting, in every state, in both urban and rural and areas”.2

Role of CRNAs in addressing opioid abuse

According to the “In Action: 2018 Response to the Opioid Crisis” report by the Centers for Disease Control and Prevention, in 2017 more than 70,000 Americans died from drug overdoses with over 47,000 of those involving illicit opioids or prescription drugs.3 CRNAs are at the frontline of the opioid crisis. Through their holistic, interdisciplinary and multi-modal approach, CRNAs play an integral role in appropriate use of opioids for patients receiving anesthesia, sedation, and pain management services for acute and chronic pain. Furthermore, as people across multiple sectors (e.g., first responders, health professionals and law enforcement) work to address the opioid crisis in America, appropriate utilization of anesthesia and pain management services is of utmost importance.4 Further, the enactment of the 2018 Support for Patients and Communities Act expanded earlier legislation (the 2016 Comprehensive Addiction and Recovery Act) to now include CRNAs among the eligible providers able to prescribe buprenorphine-containing products for the purpose of medication-assisted treatment (MAT) for individuals with opioid use disorder (OUD).5,6

By providing didactic and clinical teaching/training for NAT students in OUD management and treatment and options for non-opioid pain management and anesthesia, the NAT

1 American Association of Nurse Anesthetists. Certified Registered Nurse Anesthetists Fact Sheet.

Accessed on September 13, 2019. https://www.aana.com/membership/become-a-crna/crna-fact-sheet 2 National Board of Certification & Recertification for Nurse Anesthetists. Accessed on September 13, 2019. https://www.nbcrna.com/about-us 3 Centers for Disease Control and Prevention report: “In Action: 2018 Response to the Opioid Crisis” https://www.cdc.gov/opioids/pdf/Overdose-Snapshot-2018_Final_508.pdf 4 Elite Health Care. CRNAs on the Frontline of Fighting the Opioid Crisis. Accessed on September 13, 2019. https://www.elitecme.com/resource-center/nursing/crnas-on-the-frontline-of-fighting-the-opioid-crisis/ 5https://www.congress.gov/bill/115th-congress/house-bill/6/text?q=%7B%22search%22%3A%5B%22hr6%22%5D%7D&r=1 6https://www.aana.com/practice/clinical-practice-resources/opioid-crisis-resources/crnas-and-medication-assisted-treatment-(mat) https://www.aana.com/membership/become-a-crna/crna-fact-sheet https://www.cdc.gov/opioids/pdf/Overdose-Snapshot-2018_Final_508.pdf https://www.cdc.gov/opioids/pdf/Overdose-Snapshot-2018_Final_508.pdf https://www.elitecme.com/resource-center/nursing/crnas-on-the-frontline-of-fighting-the-opioid-crisis/ https://www.congress.gov/bill/115th-congress/house-bill/6/text?q=%7B%22search%22%3A%5B%22hr6%22%5D%7D&r=1 https://www.congress.gov/bill/115th-congress/house-bill/6/text?q=%7B%22search%22%3A%5B%22hr6%22%5D%7D&r=1 https://www.aana.com/practice/clinical-practice-resources/opioid-crisis-resources/crnas-and-medication-%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20assisted-treatment-(mat) https://www.aana.com/practice/clinical-practice-resources/opioid-crisis-resources/crnas-and-medication-%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20assisted-treatment-(mat)

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award recipients will be supporting HHS’s and HRSA’s priority to combat the opioid abuse epidemic, especially in the ways it particularly affects rural and underserved populations.

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. In addition, the following definitions apply to the NAT Program for Fiscal Year 2020.

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

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

II. Award Information

1. Type of Application and Award

Types of applications sought: New and Competing Continuation

HRSA will provide funding in the form of a grant. The amount of funding awarded to each recipient will be determined according to a formula.

2. Summary of Funding

HRSA expects approximately $2,250,000 to be available annually to fund approximately eighty (80) recipients. Awards will be distributed among all eligible institutions based on a formula calculation using data supplied by applicants in the NAT Program Specific Data Forms (see appendix). Applicants that fail to submit this information will not be considered for funding.

The Period of Performance is July 1, 2020 through June 30, 2023 (3 years). HRSA is changing the NAT Program from a one-year project period to a three-year project period, which allows a longer period for data collection and measuring project performance.

Funding beyond the first year is subject to the availability of appropriated funds for NAT in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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.

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/grants/resourcecenter/glossary

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

III. Eligibility Information

1. Eligible Applicants

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

Applicants must be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs at the time of application, and for the duration of the award, to provide registered nurses with full-time anesthetist education.

Foreign entities are not eligible for this HRSA award.

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

Domestic faith-based and community-based organizations, tribes, and tribal organizations are eligible to apply for these funds, if otherwise eligible.

In addition to the 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply.

Beneficiary (Student/Trainee) Eligibility Requirements To receive NAT traineeship support from a recipient institution, a student/trainee must be:

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

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

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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• Eligible to sit for the national certification examination to become a Certified Registered Nurse Anesthetist upon program completion; and

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

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 to be 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 for the fiscal year preceding the fiscal year for which the entity receives the award, as required Section 803(b) of the Public Health Service Act. Complete the Maintenance of Effort information and submit as Attachment 1.

Multiple Applications Multiple applications from an organization are allowable if the applications have unique DUNS numbers; however, applicants can submit only one application per campus. A campus is defined as a division of a university that has the same name yet is separate with its own grounds, buildings (e.g., school of nursing) and faculty. For example, the University of Homestate at Smalltown and the University of Homestate at Anytown can each submit an application for this program.

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.

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

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The NAT Program Specific Data Forms request information on program participants such as the number of enrollees/trainees, number of enrollees/trainees supported, number of graduates, number of graduates supported, number of projected enrollees/trainees, degree program (Master’s and Doctoral), and the distribution of Nurse Anesthetists who practice in underserved, rural, and/or public health practice settings. In FY 2019, the NAT Tables collected one year of data, which allowed HRSA to calculate award amounts for a single-year project period. For fiscal year 2020, HRSA is revising the forms that previously collected one year of data on prospective students to capture three years of data, thereby allowing HRSA to calculate award amounts for a multi-year project period. Table 1 will add columns to collect Year 2 and Year 3 data for the number of prospective students.

Table 2 data collection elements will not change; however, the instructions for completing the table and the header will change to provide further clarification about the data being collected. The new header adds Year 1 (07/01/18-06/30/19) NUMBER OF

GRADUATES.

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 appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

Length of Support

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

• Any new appointment (see program definitions in Section I.2) must be made for a period of not fewer than nine months and not to exceed a period of 12 months. The only exception to the minimum appointment is to allow a student to complete the program.

• Trainees may receive a reappointment (see program definitions in Section I.2).

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

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

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

Termination of Trainees

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

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

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

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

• Requests to terminate NAT Program support.

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

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

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the personnel requirements, assurances, certifications, project abstract, and project narrative. For the NAT Program, the budget, budget justification and staffing plans are not required. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program specific information below.

You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in terms of U.S. dollars (45 CFR § 75.111(a)).

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 30 pages when printed by HRSA. The page limit includes the abstract, project narrative, and attachments including biographical sketches (biosketches) required in HRSA’s SF-424 R&R Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do NOT count in the page limitation. Biographical Sketches do count in the page limit.

We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

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

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1. You, on behalf of the application organization certify, by submission of this proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2. Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3. Where you are unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 4: Other Relevant Documents.

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

Program-Specific Instructions

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

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

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

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

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

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

Successful applicants are encouraged to have program participants complete a profile on the HRSA Health Workforce Connector at the following link https://connector.hrsa.gov/connector/ a resource to search for health care jobs in underserved communities across the nation. Recipients are required to have all trainees obtain National Provider Identifier (NPI) numbers to aid long-term assessment of the program’s impact on access and delivery of quality health care services. Trainees who receive HRSA funds as a result of this award must apply for an NPI for the purpose of collecting post-completion employment http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://connector.hrsa.gov/connector/

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demographics, and recipients are required to report the NPI numbers for all individuals participating in the program to HRSA.

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 HHS/HRSA clinical priorities will be addressed by the project, as applicable; and

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

ii. Project Narrative

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

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

• PURPOSE AND NEED

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

• Describe and document the need for CRNAs in the benefiting community;

• Discuss the target population served by this segment of the health workforce, as well as the socio-cultural determinants of health and health disparities impacting the population or communities served. Use and cite demographic data whenever possible to support the information provided;

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

• Describe characteristics of your particular nurse anesthesia program, student population, and relevant graduate outcomes – to include the success (pass) rate of your graduates on the national certification examination. Student Registered Nurse Anesthetists must graduate from a Nurse Anesthesia educational program accredited by the Council on Accreditation (COA) and pass the certification examination administered

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by the National Board of Certification and Recertification for Nurse Anesthetists.

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

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

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

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

You must:

• Describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs;

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

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

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

• Describe how trainees will be selected and where they will train, particularly those clinical training sites affiliated with the proposed project that are located in HPSAs, or that benefit rural or underserved populations; 5

• Describe the process for encouraging graduates to find employment in rural and underserved communities using available resources as appropriate, including the HRSA Health Workforce Connector at the following link https://bhw.hrsa.gov/provider-recruitment/health-workforce-connector; and

• Describe your process to obtain NPI numbers to track trainee employment practice settings after program completion for up to five years.

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

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

5 HRSA’s HPSA Finder Tool at https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx https://bhw.hrsa.gov/provider-recruitment/health-workforce-connector https://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.aspx

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• 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, other resources);

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

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

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

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

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 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.

(b) WORK PLAN You must provide a detailed Work Plan that demonstrates your experience implementing a project of the proposed scope. A sample Work Plan can be found here:

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

You must:

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

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

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

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

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

https://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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(c) RESOLUTION OF CHALLENGES

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

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

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY

You must describe the plan for program performance evaluation that will contribute to work in continuous quality improvement. The Program Performance Evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation personnel and organizational support, collaborative partners, and other resources); key processes; variables to be measured;

expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported. You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

You must also describe the systems and processes that will support your organization's collection of HRSA’s Performance Measurement requirements for this program. At the following link, you will find the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html. Describe the data collection strategy to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes. Document the procedure for assuring the data collection, management, storage, and reporting of NPI numbers for individuals participating in the Program.

(b) PROJECT SUSTAINABILITY

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

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

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

• Recipients are expected to sustain key elements of the project, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population; and http://bhw.hrsa.gov/grants/reporting/index.html

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• You must discuss 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

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

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

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

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

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

A Biographical Sketch for the Project Director (PD) and any other key faculty/ staff (See Section IV.2.vi for full list of required attachments) must be uploaded as Attachment 3. Include biographical sketches for persons occupying key positions, not to exceed TWO pages in length each. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

Biographical sketches, 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:

• Institution and location

• Degree (if applicable)

• Date of degree (MM/YY)

• Field of study

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

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors.

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Include present membership on any Federal Government advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

• Section D (optional) Other Support. List both selected ongoing and completed (during the last three years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

iii. Budget

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

iv. Budget Justification Narrative

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

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

As part of the application submitted through Grants.gov, applicants must complete and electronically submit the NAT Program Specific Data Forms by the established and published application due date. The NAT Program Specific Data Forms are essential to determining the award calculation. For Fiscal Year 2020, HRSA is changing to a three-year project period and has revised the forms that previously collected one year of data on prospective students to capture three years of data, thereby allowing HRSA to calculate award amounts for a multi-year project period. Table 1 added data collection for the number of prospective students for Year 2 and Year 3. Table 2 data collection elements have not changed; however, the instructions for completing the table and the header will change to provide further clarification about the data being collected. The new header adds Year 1 (07/01/18-06/30/19) NUMBER OF GRADUATES.

These NAT Program Specific Data Forms are part of the electronic Grants.gov application package. Copies of the NAT Program Specific Data Forms (NAT Tables) are included for reference as an appendix to this NOFO; however, the tables must be completed online as a part of the Grants.gov application package.

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vi. Attachments

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

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

NON-FEDERAL EXPENDITURES

FY 2019 (Actual)

Actual FY 2019 non-federal funds, including in-kind, expended for activities proposed in this application.

Amount: $

FY 2020 (Estimated)

Estimated FY2020 non-federal funds, including in-kind, designated for activities proposed in this application.

Amount: $

Attachment 2: Accreditation Documentation (Required); Approval Documentation (If Applicable) The applicant organization must provide evidence of accreditation for all affiliated nursing programs: (1) a statement that they hold continuing accreditation from the relevant accrediting body and are not on probation, (2) the name of the accrediting body, (3) the date of initial accreditation, (4) the date of the next expected accrediting body review (or expiration date of current accreditation), and (5) a web link to the accreditation information on the accrediting body website (if available). The full Letter of Accreditation is not required. Applicants on provisional accreditation status must provide proof of this status. Information that cannot be verified at the accrediting body website and applications that do not include the required accreditation documentation as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

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

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

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

This includes approval from the school, the college/university and the State Board of Nursing, as appropriate. The documentation should be, for example, in the form of meeting minutes, a letter from the State Board of Nursing, or a letter from the Faculty Senate or State Finance Board as appropriate for the school.

Applications that do not include the approval documentation and cannot be verified on the website (if applicable) as specified in this NOFO will be considered nonresponsive and deemed ineligible under this funding announcement.

Attachment 3: Biographical Sketch of Project Director (Required) Include a Biographical Sketch for the Project Director, not to exceed two pages in length.

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

3. Dun and Bradstreet Universal Numbering System (DUNS) and

System for Award Management

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

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

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

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

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

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

• Grants.gov (http://www.grants.gov/)

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

SAM.GOV ALERT: For your SAM.gov registration, you must submit a notarized letter appointing the authorized Entity Administrator. The review process changed for the Federal Assistance community on June 11, 2018.

In accordance with the Federal Government’s efforts to reduce reporting burden for recipients of federal financial assistance, the general certification and representation requirements contained in the Standard Form 424B (SF-424B) – Assurances – Non- Construction Programs, and the Standard Form 424D (SF-424D) – Assurances – Construction Programs, have been standardized federal-wide. Effective January 1, 2020, the updated common certification and representation requirements will be stored and maintained within SAM. Organizations or individuals applying for federal financial assistance as of January 1, 2020, must validate the federally required common certifications and representations annually through SAM located at SAM.gov.

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

4. Submission Dates and Times Application

Application Due Date The due date for applications under this NOFO is March 6, 2020 at 11:59 p.m. ET.

HRSA suggests submitting applications to Grants.gov at least 3 calendar days before the deadline to allow for any unforeseen circumstances. See Section 8.2.5 – Summary of emails from Grants.gov in HRSA’s SF-424 R&R Application Guide for additional information.

http://www.dnb.com/duns-number.html https://www.sam.gov/ http://www.grants.gov/ http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://sam.gov/ https://www.fsd.gov/fsd-gov/answer.do?sysparm_kbid=d2e67885db0d5f00b3257d321f96194b&sysparm_search=kb0013183 https://www.sam.gov/

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5. Intergovernmental Review

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

6. Funding Restrictions

You may request funding for a period of performance of up to 3 years, for traineeships inclusive of indirect and direct costs. The FY 2020 President’s Budget does not request funding for this program. 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. Awards to support projects beyond the first budget year will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the Federal Government.

The General Provisions in Division B…