PKG00260804-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Advanced Nursing Education Nurse Practitioner Residency Integration Program

(ANE-NPRIP)

Funding Opportunity Number: HRSA-20-118 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.247

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: June 8, 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: April 6, 2020

Debra A. Parchen, MSN, RN Nurse Consultant / Project Officer Telephone: (301) 443-2597 Email: ANE-NPRIP@hrsa.gov

Authority: 42 U.S.C. § 296j (Section 811(a) of the Public Health Service Act) mailto:ANE-NPRIP@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2020 Advanced Nursing Education Nurse Practitioner Residency Integration Program (ANE-NPRIP). The purpose of this grant program is to prepare new nurse practitioners (NPs) for primary care or behavioral health practice in integrated, community-based settings, through expansions and/or enhancements to existing 12-month Nurse Practitioner Residency (NPR) programs. For this program, supported nurse practitioner education and training specialties include: Family, Adult Family, Adult-Gerontology, Pediatric, Women’s Health Care, Nurse Midwife, and Psychiatric-Mental Health.

Funding Opportunity Title: Advanced Nursing Education Nurse

Practitioner Residency Integration Program (ANE-NPRIP)

Funding Opportunity Number: HRSA-20-118 Due Date for Applications: June 8, 2020 Anticipated Total Annual Available FY 2020 Funding:

$5,000,000

Estimated Number and Type of Award(s): Approximately 5 grants Estimated Award Amount: Up to $1,000,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: No Period of Performance: September 1, 2020 through

August 31, 2023 (three years)

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Eligible Applicants: Eligible applicants are schools of nursing, nurse managed health clinics/centers, academic health centers, state or local governments and other private or public nonprofit entities determined appropriate by the Secretary. Consortia of public or private nonprofit entities that confer degrees, or provide practice support to RNs for NP education in primary care or behavioral health, or other such private or public nonprofit entities are eligible to apply under this funding opportunity. For purposes of this NOFO, a consortium should consist of at least three independent organizations that meet the above qualifications.

For-profit entities are not eligible under this NOFO.

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

Application Guide

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

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar 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/fundingopportunitiesto learn more about the resources available for this funding opportunity.

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

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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. Program-Specific Forms

vi. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: A

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Fiscal Year (FY) 2020 Advanced Nursing Education Nurse Practitioner Residency Integration Program

(ANE-NPRIP).

Program Purpose

The purpose of this program is to prepare new primary care or behavioral health nurse practitioners (NPs)1 to work in integrated, community-based settings.

Program Goals The ANE-NPRIP seeks to increase the number of new primary care or behavioral health NPs serving in integrated, community-based settings. Accredited residency programs or those residency programs in the accreditation process are encouraged to support the placement of residency completers in community-based settings in rural and underserved settings. The program also encourages applicants to assist NP residency completers to remain in these settings.

Program Objectives Expand and/or enhance existing 12-month NP residency programs that are accredited or in the accreditation process, in primary care or behavioral health and in an integrated, community-based setting.

HHS and HRSA Priorities

You are encouraged to select and address one HHS’s and HRSA’s clinical priorities below.

• Ending the crisis of opioid addiction and overdose in America

• Improving mental health access and care

• Transforming the health care system through value-based care delivery and quality improvement initiatives

• Transforming the workforce –by targeting the need

• Strengthening health care access through telehealth

• Preventing and reducing childhood obesity

• Preventing and reducing maternal mortality

• Ending the HIV epidemic

HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, Technical Assistance, and training, visit:

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

1 For this program, NP specialties are limited to: Family, Adult Family, Adult-Gerontology, Pediatric, Women’s Health Care, Nurse Midwife, or Psychiatric-Mental Health.

https://www.hrsa.gov/opioids

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HRSA has a number of investments targeting use of telehealth across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, Technical Assistance, and training, visit: https://www.hrsa.gov/rural-health/telehealth.

2. Background

This program is authorized by Section 811(a) of the Public Health Service Act (42 U.S.C. § 296j) to support projects that support the enhancement of advanced nursing education and practice.

The demand for primary care services has increased largely due to both a growing population and an aging population. Integrating primary care with behavioral health care, where clinicians collaborate in addressing the needs of the whole person, increases coordination and communication towards a unified set of health goals, while reducing costs, enhancing the experience for patients, and improving population health.2,3,4

HRSA’s National Center for Health Workforce Analysis projects the demand for primary care physicians will increase by 38,320 full time employees (FTEs) constituting a 17 percent increase (from 224,780 FTEs in 2013 to 263,100 FTEs in 2025).5 This projected demand in primary care services would result in a shortage of 23,640 physicians needed to provide primary care.6 In 2016, NCHWA estimated that 18.3 percent of the U.S. adult population suffered from a mental illness, and 28.6 million people used an illicit drug in the past 30 days.7 Expanding the role of advance practice registered nurses is anticipated to help meet this need for primary care and behavioral health services.

Improving access to primary care providers, like doctors and advance practice registered nurses, is especially important in rural and underserved areas. Rural areas also have proportionally fewer providers in the types of health occupations that tend to require more education and training.8 In addition, these areas often face significant

2 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (N.D.) What Is Integrated Behavioral Health? Retrieved from https://integrationacademy.ahrq.gov/about/what-integrated-behavioral-health 3 Katon WJ, Unutzer J. (2013). Health reform and the Affordable Care Act: the importance of mental health treatment to achieving the triple aim. Journal of Psychosomatic Research, 74(6), pp. 533-537.

4 Ross, K. M., Klein, B, Ferro, K., McQueeney, D.A., Gernon, R. & Miller, B. (2019). The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice to Facilitate the Integration of Care: A Prospective, Case–Control Program Evaluation. Journal of Clinical Psychology in Medical Settings, 26(1), pp. 59-67.

5 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.

Rockville, Maryland. Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013- 2025.pdf.

6 Id.

7 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2019. Behavioral Health Workforce Projections, 2016-2030. Rockville, Maryland.

Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/Behavioral- Health-Workforce-Projections.pdf 8 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Distribution of U.S. Health Care Providers Residing in Rural and Urban areas. Rockville, Maryland: U.S.

Department of Health and Human Services, 2014. Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/nchwafactsheet.pdf.

https://www.hrsa.gov/rural-health/telehealth https://www.hrsa.gov/rural-health/telehealth https://integrationacademy.ahrq.gov/about/what-integrated-behavioral-health https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/nchwafactsheet.pdf

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health challenges and health disparities.9 HRSA identified 6,117 mental health provider shortage areas (HPSAs) in the U.S., with 3,730 (60.98 percent) of them situated in rural and partially rural areas.10 Addressing the gap in primary care providers for rural and underserved populations is of the utmost importance for the health of the Nation.

Nurses, specifically NPs in primary care, can help to address this gap, especially when they are working at the top of the scope of licensure.11

The National Academy of Sciences recommends establishing ways to develop and finance nursing residency programs, which provide a bridge to practice.12 NPs are expected to carry a full provider patient load upon graduation and after obtaining licensure/certification. Providing care for rural and underserved populations can be complex and challenging for a new NP graduate transitioning to practice in a rural and underserved setting.13,14 Although expected to carry a full patient care load upon acquiring their first job, some new NPs report feeling overwhelmed, and especially so when serving patients from rural and other underserved populations.15

The ANE-NPRIP facilitates the development of rigorous primary care clinical practice residencies to increase and fortify clinical knowledge and skills and provides an advantageous transition to practice. NPRIPs will allow for the additional opportunity to increase and fine tune health care skills with the presence and guidance of a preceptor.

Further, a residency with an academic affiliation will enable the development and standardization of curricula and competencies.16 For states requiring a transition to practice period, the NPRIP Program may meet this requirement (assuming it meets all the documented requirements outlined in this NOFO, i.e., community-based academic partnership providing primary care or behavioral health, with a preference for those serving rural and/or underserved populations) based on the preceptorships and oversight provided during the residency rotation.

The lower concentration of NPs in rural and underserved areas relative to urban and other settings contributes to the challenges of meeting the health needs of these populations, who have complex health care needs requiring knowledgeable and skilled primary care providers.17 Post-graduation rural employment by nursing students seems

9Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W. (2015). Rural Healthy People 2020: New Decade, Same Challenges. The Journal of Rural Health, 31, 326–333. doi:10.1111/jrh.12116 10 Health Resources & Services Administration. (2019). First quarter of fiscal year 2020 designated HPSA quarterly summary.

Retrieved from https://data.hrsa.gov/topics/health-workforce/shortage-areas 11 Recruiting and Maintaining U.S. Clinical Training Sites: Joint Report of the 2013 Multi-Discipline Clerkship/Clinical Training Site Survey (2014). Retrieved from https://members.aamc.org/eweb/upload/13-225%20WC%20Report%202%20update.pdf 12National Academies of Sciences, Engineering, and Medicine. (2016). Assessing Progress on the Institute of Medicine Report: The Future of Nursing. Washington, DC: The National Academies Press. https://doi.org/10.17226/21838.

13 Flinter, M., & Hart, A. M. (2017). Thematic elements of the postgraduate NP residency year and transition to the primary care provider role in a Federally Qualified Health Center. Journal of Nursing Education and Practice, 7(1), 95-106.

14 Rieselbach, R. E., Crouse, B. J., & Frohna, J. G. (2010). Health centers: Addressing the workforce crisis for the underserved.

Annals of Internal Medicine, 152, pp. 118-22.

15 Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. Retrieved from https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf.

16 Harper, D., McGuinness, T., Johnson, J. (2017). Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation? Nursing Outlook, 65(1), pp. 50-57. doi: 10.1016/j.outlook.2016.08.004 17 Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. Retrieved from https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf.

https://data.hrsa.gov/topics/health-workforce/shortage-areas https://members.aamc.org/eweb/upload/13-225%20WC%20Report%202%20update.pdf https://doi.org/10.17226/21838 https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf

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to be linked to life experiences in and connections to small communities as well as exposure to rural practice settings during training.18 Graduate nursing students who attended a program with a rural focus also seem to be more likely to practice in rural areas.19 As such, assuring the required skill set and addressing the maldistribution of clinicians can be addressed through a NPRIP program.

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 ANE-NPRIP:

Consortium – An association or agreement of at least three separately owned and governed, public or private nonprofit entities that confer degrees or provide practice support, formed to undertake an enterprise beyond the resources of any one member.

A consortium has a clearly documented, binding agreement of resource support and roles/responsibilities (See Attachment #6). Consortiums are able to align resources and strategies, achieve economies of scale and efficiency, and address challenges more effectively as a group than as single entities. For the purposes of this program, each entity making up the consortium meets the program’s eligibility criteria in Section III.1 of the NOFO, and the applicant has the legal authority to apply and to receive the award.20 An entity can be a partner to multiple ANE-NPRIP NOFO applications, but can only be an applicant on one application.

Faculty Paid Release Time – Release time is administratively authorized time spent away from the employee’s normal job responsibilities to participate in sponsored or sanctioned programs without loss of pay and without charge to paid time off (PTO) leave. Release time is considered work time; therefore, such time is counted when computing overtime.

Infrastructure – The basic operational costs needed to manage the NPRIP program.

Maldistribution – Shortages of health care providers in some locations, such as rural and underserved areas, with other locations having a sufficient or an excess number of health care providers.

Meaningful Use of Technology – Meaningful Use is defined by the use of certified Electronic Health Record (EHR) technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and that in using certified EHR technology the provider must submit to the Secretary of Health & Human Services (HHS) information on quality of care and other measures. Examples include, but are not limited to, telehealth, health informatics, 18 Bushy A, Leipert BD. Factors that influence students in choosing rural nursing practice: a pilot study. Rural Remote Health. 2005 Apr-Jun;5(2):387. Epub 2005 Apr 19.

19 Fatima, Y., Kazmi, S., King, S., Solomon, S. & Knight, S. (2018). Positive placement experience and future rural practice intentions: Findings from a repeated cross-sectional study. Journal of Multidisciplinary Healthcare, 11, 645-652

20 2 CFR 25.200.

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

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and/or others that are in compliance with Health Information Portability and Accountability Act.

NP Residency Accreditation – For the purposes of this NOFO, a NP residency program is a program officially recognized as meeting all of the NP residency accreditation standards of practice by a national NP residency accrediting organization.

Residency – A training program that provides an individual or group of individuals (known as "residents") with post-graduate advanced clinical training.

Resident – For the purposes of this NOFO, a resident is a licensed and certified NP who is enrolled with a government or private payer so that direct billing is possible for their own patient visits.

Social determinants of health (SDOH) – This include factors like socioeconomic status, neighborhood and physical environment, social support networks, community violence, and intimate partner violence. SDOH affect a wide range of health, functioning, and quality-of-life outcomes and risks. Addressing SDOH, such as intimate partner violence, is a HRSA objective to improve the health and well-being of individuals and the communities in which they reside.

Sustainability – The ability to be sustained, supported, upheld, or confirmed. Projects under this Program will demonstrate sustainability by continuing their 12-month ANE- NPRIP without federal funding support after the period of performance ends.

Telehealth – The use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Underserved – Refers to a population not receiving adequate health care, for example, due to inability to pay or barriers to health care access.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

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2. Summary of Funding

HRSA expects approximately $5,000,000 to be available annually to fund approximately five recipients. You may apply for a ceiling amount of up to $100,000 annually per NP resident (includes both direct and indirect, facilities and administrative costs) per year.

HRSA expects each applicant to train no less than four NP residents annually, but no more than 10 NP residents annually.

This funding covers all project costs for the awardee, not just NP resident salaries.

The period of performance is September 1, 2020 through August 31, 2023 (3 years).

Funding beyond the first year is subject to the availability of appropriated funds for the ANE-NPRIP 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.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are accredited schools of nursing, nurse managed health clinics/centers, academic health centers, state or local governments and other private or public nonprofit entities determined appropriate by the HHS Secretary. For the purposes of this NOFO, FQHCs are eligible applicants.

The NP residency program must be accredited by a recognized, professional NP accreditation organization, or be in the process of accreditation.21 At minimum, the applicant has completed the NP residency program self-assessment and has submitted either a notice of intent to apply or an application to a NP residency accrediting organization. The most successful applicants will have either an accredited NP residency program, or have had the initial on site full assessment by the NP residency accrediting organization. The NP residency program must maintain its accreditation throughout the period of performance. Loss of active accreditation status may be cause for HRSA to cease or reduce recipient funding levels beyond the first project period year.

Consortiums may apply for these funds, if otherwise eligible. Each entity must meet the eligibility requirements for this NOFO. HRSA will make one award per consortium to the applicant of the consortium provided it is an eligible entity and has the legal authority to apply for and to receive the award on behalf of the other consortium members. An entity can be a partner to multiple ANE-NPRIP NOFO applications, but can only be an applicant on one application. See Section III.2 Eligibility – Other, below.

21 American Nurses Credentialing Corporation Practice Transition Accreditation Program (https://www.nursingworld.org/organizational- programs/accreditation/ptap/), National Nurse Practitioner Residency and Fellowship Training Consortium (https://www.nppostgradtraining.com/) http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.nursingworld.org/organizational-%20programs/accreditation/ptap/ https://www.nppostgradtraining.com/

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

In addition to the 50 states, only eligible applicants in 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.

Individuals and for-profit entities are not eligible applicants under this NOFO.

Individuals should consult directly with the academic institution where they receive their training (not HRSA) regarding components of or experiences at that training program.

Beneficiary Eligibility for NP Resident Participants To be eligible for the ANE-NPRIP, the NPs trained through the support provided by this HRSA program must meet all of the following:

• Be a graduate from a Primary Care or Behavioral Health NP Program, have an NP certification and be licensed and certified no longer than 18 months before the start of the residency program;

• Be a citizen of the U.S., a non-citizen national, or a foreign national who possesses a visa permitting permanent residence in the U.S. Individuals on temporary or student visas are not eligible to receive ANE-NPRIP support;

and

• Agree to be a full-time participant in the ANE-NPRIP; NPs enrolled in graduate school (i.e., completing a master’s or doctoral degree) at the start of the NP residency program are not eligible NP residents.

Appointment of NP Residents and Length of Support22 NPs in primary care or behavioral health who agree to commit to a full-time residency program in a community-based setting qualify for an appointment as an ANE NP resident.

An NP resident may be appointed at the beginning of any residency period, including a summer session, which falls within the budget period. All NP residents must be full-time in the residency program. HRSA financial support is limited to 12 consecutive months for any one NP resident. The most successful projects utilize a documentation process as a part of their hiring/onboarding that is compliant with the provisions of this NOFO (and all applicable programmatic and grant requirements), is signed by the Project Director and NP resident, and is maintained by the recipient institution for a period of at least three years after submission of the final expenditure report, primarily for auditing and data collection purposes.

NP residents must agree to provide the recipient institution with the following:

• The necessary information to complete the project’s hiring/onboarding documentation. The NP resident should receive a copy of the completed documentation;

22 Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community Health Centers. See pages 103 & 114. Retrieved from

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• Data regarding professional activity following completion of the ANE-NPRIP;

and

• A National Provider Identifier (NPI) number.

Note: An entity must contact the HRSA project officer for any requested change in NP resident status.

Funding will not follow an individual NP who transfers out of the awardee’s program, even if the program accepting that resident is also a recipient of ANE-NPRIP or another HRSA grant program. If a resident (or residents) transfer(s) out of the awardee’s program, HRSA’s funding to the awardee will be reduced by up to $100,000 annually per transferred resident.

Termination of Nurse Practitioner Residents The recipient institution is responsible for monitoring the success of each NP resident.

In monitoring the residents, awardees must agree to the following guidelines related to residents and cease funding NP residents in the following circumstances:

• If a resident is unable to complete the residency program supported by the ANE-NPRIP award;

• If a resident withdraws from the recipient institution prior to the scheduled completion of the ANE-NPRIP;

• If a resident fails to meet the predetermined academic standards of the recipient institution; or

• If a resident requests to terminate the ANE-NPRIP support.

The ANE-NPRIP awardee should have standard operating procedures in place for the recruitment, training, retention, rescheduling, and termination of participants for the ANE-NPRIP Program. If a portion of the ANE-NPRIP training needs to be repeated, scheduling this activity to occur immediately following the conclusion of the award recipient cohort’s ANE-NPRIP is strongly encouraged and guidelines on this process should be incorporated into the standard operating procedures. Guidelines on how to recoup costs obligated in the case of termination of participants should also be included in the standard operating procedures.

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2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount The ceiling amount is based directly on the number of NPs supported in the residency program multiplied by $100,000 per year, at a minimum of $400,000 per year with 4 NPs and a maximum of $1,000,000 per year with 10 NPs. HRSA will consider any application that exceeds the ceiling amount per year non-responsive and will not consider it for funding under this notice. Refer to the budget information section for more specific information.

Accreditation HRSA will consider any application that fails to include the required accreditation documentation in Attachments 1, 2 and/or 3 non-responsive and will not consider it for funding under this notice. Organizations that are in the process of having their NP residency program accredited at the time of application submission must receive accreditation by September 30, 2021. If any accreditation is lost or expires during the period of performance, HRSA may take appropriate action.

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 receiving the award, as required. Complete the Maintenance of Effort information and submit as Attachment 8.

Multiple Applications Multiple applications from an organization are not allowable. Eligible applicants can submit only one application per organization, campus, clinical facility, or consortium;

multiple applications from a single organization, campus, clinical facility, or consortium are not allowable. A campus is defined as a division of a university that has its own grounds, buildings (e.g., school of nursing) and faculty. A clinical facility is defined as a health care facility, whether part of a system or not, which has its own grounds containing its own leadership (chief nursing officer, chief medical officer, chief executive officer, etc.). Independent organizations are those entities that have 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 the applicant’s last validated electronic

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submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires applicants to apply electronically. HRSA encourages applicants to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You are strongly encouraged to select “subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

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 this NOFO.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. Applicants must submit the information outlined in the SF- 424 R&R Application Guide in addition to the program-specific information below.

Applicants 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. Applicants must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

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

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

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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Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. The Research and Related Senior/Key Person Profile (Expanded) form itself does not count against the page limit, but the attached biographical sketches do count in the page limitation. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-20- 118, it may count against the page limit. Therefore, only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit.

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

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

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 13: 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 Applicants must demonstrate to HRSA that they will be able to carry out the following activities:

1) Conduct a Primary Care or Behavioral Health NP-Residency Program in an Integrated Community Based Setting:

a. The program must establish linkages, as required by PHS Act section 802(d), with relevant educational and health care entities for the project and must have in place or establish an academic clinical partnership to develop and implement the ANE-NPRIP Program.

b. This partnership must include:

i. an ongoing feedback mechanism with rapid cycle quality improvement (RCQI);

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ii. an academic clinical partnership Advisory Council and a schedule of reoccurring meetings (e.g., at least quarterly) as part of a multifaceted feedback loop for RCQI.

c. The program must provide NP resident support in the form of salaries to full-time residents who are licensed and certified NPs receiving 12 continual months of immersive clinical and didactic training at a primary care or behavioral health community-based entity.

2) Recruit Participants:

a. Applicants must document the utilization of standardized outreach, recruitment and retention plans to engage state licensed and certified NPs in the specialty areas of primary care or behavioral health focus at the time of starting the program.

b. Applicants must document a targeted pool of NPs by geographic area (region, state, county or local area), and how they will recruit NPs from this pool who have demonstrated a desire to practice in community-based settings, particularly in rural and/or underserved settings, upon program completion.

3) Train Participants:

a. Training at the ANE-NPRIP residency program must begin by January

15, 2021.

b. Applicants must provide interprofessional team-based, clinical, and didactic training experiences along the practice continuum in integrated community-based settings. This Interdisciplinary team-based clinical practice training model must incorporate clinical rotations from both routine to specialty clinics.

c. The most competitive applicant training programs should include preceptor development and NP primary care or behavioral health competencies with a rural or underserved population-specific curriculum.

d. The training programs are encouraged to incorporate telehealth and meaningful use of technology (i.e., health informatics, and/or others that are in compliance with Health Insurance Portability and Accountability Act).

4) Create Linkages:

a. Each academic clinical partnership must have a signed Memorandum of Understanding (MOU), which outlines specific aspects of the partnership: name of partnership applicant organization, name and address of partner(s) and timeframe of agreement. The MOU must also document the mutual benefit of the academic practice partnership, telehealth collaboration, agreement to participate in RCQI meetings and carry out related activities, and strategize for sustainability, curriculum development, and other types of support to be provided by

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members of the partnership (placement of NP graduates, curriculum development, etc.) (See Section iv - Budget Justification).

b. Consortiums (as applicable) must have a binding relationship and signed agreement (Attachment 6) between/among the community-based entity members and the academic partner, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

c. If the applicant determines the need, funds may be used to secure technical assistance for ANE-NPRIP Program expert consultation.

Helpful resources for technical assistance ANE-NPRIP Program consultation are listed below:

i. American Nurses Credentialing Corporation Practice Transition Accreditation Program https://www.nursingworld.org/organizational-programs/accreditation/ptap/

ii. National NPR and Fellowship Training

5) Employment Assistance Post Residency – Applicants must explain how they plan to implement employment assistance strategies to connect residency program participants to employment, especially in rural and/or underserved areas.

a. Recruit, train, develop, support, and evaluate preceptors as program collaborators to enhance NP resident, preceptor, and clinical staff professional development.

b. Connect program graduates with the HRSA Health Workforce Connector (https://connector.hrsa.gov/connector/) and other existing employment support resources so they can obtain employment providing primary care or behavioral health to rural and/or underserved populations, preferably community-based clinical settings.

6) Participate in Cohort Collaboration - To provide support and ensure project success, collaborate (face-to-face and/or virtually) at a minimum of at least quarterly in the first project year and at least twice annually during the period of performance with other ANE-NPRIP Program award recipients and participate in HRSA-driven program evaluations during and upon completion of the period of performance.

7) Designate Project Staff - Applicants must identify appropriate personnel to carry out the ANE-NPRIP project. HRSA believes an effective ANE-NPRIP Program may generally include, but are not limited to many of the following personnel (or similar roles):

a. Health Education Specialist (HES)

b. Health Education Coordinator (HEC)

c. Health Information Technology Coordinator (HITC)

d. Evaluation Coordinator

e. Clinical Liaison Lead (CLL) https://connector.hrsa.gov/connector/

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

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

The Abstract must include:

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

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

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

4. How the proposed project for which funding is requested will be accomplished

(i.e., the "who, what, when, where, why and how" of a project);

5. Description of project’s behavioral health integration, if applicable;

6. Type of funding preference requested, if applicable;

7. The number of NPs in total, and by specialty, as applicable;

8. NP residency start date for each year; and

9. The funding amount requested.

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.

Applicants who propose a telehealth component to their work plan are encouraged to reach out to one of the twelve HRSA-supported Regional Telehealth Resource Centers located at https://www.hrsa.gov/rural-health/telehealth/index.html, which provide technical assistance to organizations and individuals who are actively providing or interested in providing telehealth services to rural and/or underserved communities.

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

First, briefly describe the purpose of the proposed project. Outline the needs of the community and the proposed training program. The applicant must describe and document: 1) the need for the NP training by discipline; 2) the training plan and how it integrates behavioral health into primary care, or primary care into behavioral health, as applicable, and 3) the employment placement plan post residency program. Use and cite demographic data whenever possible to support the information provided.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://www.hrsa.gov/rural-health/telehealth/index.html

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You must:

• Discuss the need for these funds, and how the proposed project activities will strengthen the applicant’s ability to increase the distribution and readiness of primary care or behavioral health NPs in community-based rural and underserved settings, as applicable;

• Describe the community that will benefit from the proposed project activities. Include information, and quantitative data to the extent feasible, such as the demographics of the population, the health status of the community, health literacy, SDOH, rural and/or underserved status, relevant barriers or gaps in accessing primary or behavioral care and other elements in support of your proposal;

• Describe the need for primary care or behavioral health NP residency programs in the benefiting community, including a description of the catchment area where the NP residents supported by the ANE-NPRIP program will most likely and/or intend to be employed following completion of the ANE-NPRIP (Attachment 12);

• Include the proposed number and specialty of NPs the ANE-NPRIP will support for each of the three project years, and data describing where those participants are currently employed and/or the school of nursing from which they recently graduated;

• Discuss the applicant organization’s willingness to, or past performance in, collaborating with a group of fellow HHS grant recipients; and

• Describe the number of NPs who have been targeted to participate as preceptors in the ANE-NPRIP, or who have at least two years of experience, the demographics of those NPs, their specialty23 and data describing where those potential preceptors are currently employed, if not with the applicant organization.

o We anticipate that competitive applicants will build a pipeline of preceptors for the ANE-NPRIP using nursing staff at primary care or behavioral health delivery sites in rural and underserved areas such as FQHCs, Community Health Centers and Rural Health Clinics. Additionally, current or former HRSA scholars that have been trained or have demonstrated a commitment to work with rural or underserved populations should be considered.24 o The following are links to some HRSA programs that may be resources for building a primary care or behavioral health NP resident pipeline:

→ Nurse Corps Scholarship Program https://bhw.hrsa.gov/loansscholarships/nursecorp s/scholarship

23 For this program, NP specialties are limited to: Family, Adult Family, Adult-Gerontology, Pediatric, Women’s Health Care, Nurse Midwife, or Psychiatric-Mental Health.

24 Nurse Corps or NHSC Scholars could be beneficiaries of the ANE-NPRIP program, in that they could defer their service obligation in order to receive further training through the ANE-NPRIP program. Once the one year post graduation training has been completed, they would complete their service obligation in a designated facility. Nurse Corps and NHSC loan repayment participants that are currently fulfilling service obligations could serve as preceptors for the ANE-NPRIP Program, however such a role would not be required under the terms of their NHSC or Nurse Corps obligation. Once completing their HRSA service obligations, Nurse Corps and NHSC loan repayment alumni could also serve as preceptors for the ANE-NPRIP program. Since they would have already completed their service obligations, they would have first-hand experience working with rural or underserved populations—thus a benefit to the site and to the community being served.

https://bhw.hrsa.gov/loansscholarships/nursecorps/scholarship https://bhw.hrsa.gov/loansscholarships/nursecorps/scholarship https://bhw.hrsa.gov/loansscholarships/nursecorps/scholarship

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→ National Health Service Corps Scholarship Program https://www.nhsc.hrsa.gov/scholarships /index.html

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

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

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

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

You must:

• Provide a detailed description of the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance summarized in a table format with numbered goals/ objectives/sub-objectives, activities and corresponding timeframe in quarter periods, and responsible person(s);

• Provide a comprehensive overview of the ANE-NPRIP and documentation of commitment and plans to develop an NP resident and preceptor curriculum; list models that have been reviewed for this project;

• Describe the evidence based plan for determining quantifiable NP resident and preceptor level of practice readiness;

• Provide interprofessional team-based care with clinical, and didactic training experiences along the practice continuum in integrated, community-based settings;

• The most competitive applicant training programs have integrated behavioral health and should include preceptor development and NP primary care or behavioral health competencies with a rural or underserved population-specific curriculum;

• Identify meaningful support and collaboration with key…