PKG00261295-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Office of Rural Health Policy

Rural Residency Planning and Development Program

Funding Opportunity Number: HRSA-20-107

Funding Opportunity Type: New Assistance Listings (CFDA) Number: 93.155

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: June 30, 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 29, 2020

Sheena Johnson, MPH Health Insurance Specialist Federal Office of Rural Health Policy Telephone: (301) 945-9639 Email: ruralresidency@hrsa.gov

Authority: 42 U.S.C. 912(b)(5).

mailto:%20ruralresidency@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2020 Rural Residency Planning and Development (RRPD) Program.

The purpose of this program is to develop newly accredited and sustainable rural residency programs in family medicine, internal medicine, public health and general preventive medicine, psychiatry, general surgery, and obstetrics and gynecology, to support expansion of the physician workforce in rural communities.

The new rural residency programs will: (1) achieve accreditation through the Accreditation Council for Graduate Medical Education (ACGME), (2) ensure sustainability through public or private funding beyond the RRPD period of performance, and (3) track residents’ career outcomes post-graduation, including but not limited to retention in rural communities.

Funds will support planning and development costs accrued while achieving program accreditation. Hospitals, medical schools and community-based ambulatory settings that have a rural designation along with consortia of urban and rural partnerships are eligible to apply for a grant award.

Funding Opportunity Title: Rural Residency Planning and Development

Program Funding Opportunity Number: HRSA-20-107 Due Date for Applications: June 30, 2020 Anticipated Total Annual Available FY 2020 Funding:

$8,250,000

Estimated Number and Type of Awards:

Up to 11 grants

Estimated Award Amount: Up to $750,000 for the 3 year period of performance and awarded in Year 1

Cost Sharing/Match Required: No Period of Performance: September 1, 2020 through August 31, 2023

(3 years) Eligible Applicants: Eligible applicants* include domestic public, private and nonprofit organizations:

1) rural hospitals

2) rural community-based ambulatory patient care centers including federally qualified health centers, community mental health centers or rural health clinics

3) health centers operated by the Indian Health service, tribes or tribal organizations, or an urban Indian organization

4) graduate medical education consortiums

5) faith-based and community-based organizations, capable of carrying out the grant activities

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*Either the applicant organization or a consortium’s primary training partner must be located in a rural area.

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 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA has scheduled the following technical assistance webinar to help you understand, prepare, and submit an application for this NOFO. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Webinar

Day and Date: Friday, May 15, 2020 Time: 2 – 3 p.m. ET Call-In Number: 1-800-857-5025 Participant Code: 3414395 Weblink: https://hrsa.connectsolutions.com/rrpd_ta_2020/ Playback Number: 1-866-360-3307 Passcode: 51520 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/rrpd_ta_2020/

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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 Narrative

v. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: RESOURCES

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Rural Residency Planning and Development (RRPD) Program. The purpose of this grant program is to support the development of new rural residency programs in family medicine, internal medicine, public health and general preventive medicine (hereafter referred to as “preventive medicine”), psychiatry, general surgery, and obstetrics and gynecology, to address the physician workforce shortages and challenges faced by rural communities.

Rural residency programs are accredited medical residency training programs that primarily train residents in rural training sites for greater than 50 percent of their total time in residency, and focus on producing physicians who will practice in rural communities. One common model is the 1+2 Rural Training Track (RTT), where the first year of training occurs within a larger program, typically in an urban hospital or academic medical center, and the final two years in a rural health facility.

Program Goal

The goal for the RRPD program is for each recipient to establish a new rural residency program that is accredited by the Accreditation Council on Graduate Medical Education (ACGME) and has a strong sustainability plan for a stable future financial outlook by the end of the period of performance. All RRPD program recipients should be capable of effectively training physicians to practice in and meet the clinical needs of rural populations. As a result, the proportion of graduates from these programs entering careers in practices primarily serving rural populations is expected to markedly exceed that seen in other programs across the nation.

Program Objectives

1. Residency Program Development – develop a newly accredited, rural residency program in family medicine, internal medicine, preventive medicine, psychiatry, general surgery, or obstetrics and gynecology that is ready to begin training its first class of residents no later than the academic year (AY) immediately following the end of the RRPD period of performance.

2. Program Sustainability – have a clearly defined, factual, and validated sustainability plan that includes ongoing funding stream(s) to sustain long-term resident training once the program is established through the following options:

A. Qualifying under current regulatory authority for Medicare graduate medical education (GME) payments in rural hospitals starting a new residency training program.1 Specifically, the applicants:

i. Either have a viable direct GME Per Resident Amount or are eligible to establish one after training residents for the first time, and

1 CMS’s criteria for determining if a program is new are in the August 27, 2009 Federal Register, page 43908:

http://www.gpo.gov/fdsys/pkg/FR-2009-08-27/html/E9-18663.htm

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ii. Eligible for a viable indirect GME and direct GME resident cap adjustment.

B. Creating an RTT program in accordance with Medicare regulations2,3 C. State or other public and/or private support D. Combination of multiple funding streams (e.g., a hospital may have a mix of Medicare and other public funding)

Refer to Section IV.2.ii. Program Sustainability for further details.

3. Graduate Tracking Plan – provide a structured plan to track and publicly report on residents’ career outcomes after graduation for a period of at least 5 years after the first graduating class to determine retention in rural communities.

Examples of information collected may include, but not limited to practice specialty/sub-specialty and location, patient population served, service time committed to the care of safety net patients, part/full-time clinical practice status, services offered, proportion of clinical time in inpatient and outpatient settings, and any additional training opportunities pursued after residency completion.

In addition, programs should: 1) provide interprofessional training specific to the needs of their rural community which may include training with behavioral health professionals, nutrition specialists and pharmacists; 2) describe any special populations served by the training program and that trainees are immersed in the care of, such as members of tribal communities, veterans, people living with HIV, patients with under- and uninsurance, patients with substance use disorder, or other groups served by HRSA programs; and 3) address other known challenges specific to rural residency programs such as having sufficient specialty and subspecialty preceptors and ensuring residents will encounter a high enough volume of patients.

2. Background

This program is authorized by 42 U.S.C. § 912(b)(5), and will be administered by the Health Resources and Services Administration’s (HRSA’s) Federal Office for Rural Health Policy (FORHP), in consultation with the Bureau of Health Workforce (BHW).

FORHP is the focal point for rural health activities within the Department of Health and Human Services (HHS). FORHP is statutorily required to advise the Secretary of HHS on the effects of current policies and proposed statutory, regulatory, administrative and budgetary changes in Medicare and Medicaid programs, on the financial viability of small rural hospitals, on the ability of rural areas to attract and retain physicians and other health professions, and on access to and the quality of health care in rural areas.

BHW improves the health of the nation's underserved communities and vulnerable populations by developing, implementing, evaluating, and refining programs that strengthen the nation's health care workforce. BHW priorities are to: 1) transform the

2 CMS’s rules and regulations for RTT programs are available at 42 CFR 413.79(k) https://www.ecfr.gov/cgi-bin/text-idx?SID=18471fdd458764a020f9e04e55230a38&mc=true&node=pt42.2.413&rgn=div5 3 CMS’s policy updates for RTT programs are available in the August 22, 2016 Federal Register, page 57027:

https://www.govinfo.gov/content/pkg/FR-2016-08-22/pdf/2016-18476.pdf https://www.hrsa.gov/rural-health/index.html https://www.hrsa.gov/rural-health/index.html https://bhw.hrsa.gov/ https://www.ecfr.gov/cgi-bin/text-idx?SID=18471fdd458764a020f9e04e55230a38&mc=true&node=pt42.2.413&rgn=div5 https://www.ecfr.gov/cgi-bin/text-idx?SID=18471fdd458764a020f9e04e55230a38&mc=true&node=pt42.2.413&rgn=div5 https://www.govinfo.gov/content/pkg/FR-2016-08-22/pdf/2016-18476.pdf

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health care workforce by creating training opportunities, incentives, and sustained support for clinicians working in rural and underserved areas, 2) increase access to behavioral health services, including substance use disorder treatment, 3) use health care workforce data to inform program and policy decisions.

Approximately 18 percent of the population, roughly 57 million individuals, live in rural communities4. Residents of rural communities typically are older than their urban counterparts are and generally experience higher frequency of chronic disease.

Coupled with these demographic characteristics, rural Americans often have poorer health status than urban counterparts5, likely due in part to challenges in accessing health care such as limited transportation options, geographic isolation, and lack of infrastructure. In particular, rural communities are much less likely to have the health professionals necessary to adequately care for their communities’ needs.

Of the nearly 2,000 rural counties in the United States (U.S.), 1,895 (95 percent) are entirely or partially in a primary care health professional shortage areas (HPSAs).6

However, higher primary care physician densities in rural areas correlate with increased quality of care and reduced rates of hospitalization for certain conditions.7 Rural areas also often lack access to behavioral health providers that they critically need - 80 percent of non-core rural counties do not have a psychiatrist.8 Enrolling trainees with rural backgrounds and training residents in rural settings are strategies shown to successfully encourage graduates to practice in rural settings.9

In FY 2018, HRSA funded a cooperative agreement (HRSA-18-117) to establish a RRPD Technical Assistance Center (RRPD-TA) to identify and work with applicants and support RRPD award recipients (HRSA-19-088) in establishing new rural residency programs. All RRPD recipients are required to collaborate with the RRPD-TA center during the period of performance and attend virtual and in-person annual meetings.

Additionally, recipients that have the same or adjacent target areas are required to collaborate with each other in conjunction with the RRPD-TA center to meet the goals and objectives of the RRPD award.

Contingent on the availability of resources, the secondary purpose of the RRPD-TA is to provide technical assistance to other entities that a) would have been eligible for the RRPD program but did not apply, or b) were not selected for a RRPD program award.

More information about RRPD-TA is available at www.ruralgme.org.

4 HRSA Federal Office of Rural Health Policy: https://www.hrsa.gov/rural-health/about-us/definition/index.html 5 ASPE Issue Brief: https://aspe.hhs.gov/system/files/pdf/211061/RuralHospitalsDSR.pdf 6 Department of Health and Human Services, Health Resources and Services Administration Data Warehouse, October 2019.

7Alex McEllistrem-Evenson. Informing Rural Primary Care Workforce Policy: What Does the Evidence Tell Us?:

A Review of Rural Health Research Center Literature, 2000-2010. April 2011. Available at:

https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a 8 Larson EH, Patterson DG, Garberson LA, Andrilla CHA. Supply and Distribution of the Behavioral Health Workforce in Rural America. Data Brief #160. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, Sep 2016. Available at: https://www.ruralhealthresearch.org/publications/1058 9 Rosenthal TC, McGuigan MH, Anderson G. Rural residency tracks in family practice: graduate outcomes. Fam Med. 2000;32:174 –7.

https://www.hrsa.gov/grants/find-funding/hrsa-18-117 https://www.hrsa.gov/grants/find-funding/hrsa-19-088 http://www.ruralgme.org/ https://www.hrsa.gov/rural-health/about-us/definition/index.html https://aspe.hhs.gov/system/files/pdf/211061/RuralHospitalsDSR.pdf https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a https://www.ruralcenter.org/resource-library/informing-rural-primary-care-workforce-policy-what-does-the-evidence-tell-us-a https://www.ruralhealthresearch.org/publications/1058

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Program Definitions

The following definitions apply to the RRPD Program for Fiscal Year 2020:

1. Centers for Medicare & Medicaid (CMS) Rural – CMS defines rural in accordance with Medicare regulations at 42 CFR 412.64(b)(ii)(C); that is, a rural area is an area outside of an urban Metropolitan Statistical Area. This excludes hospitals that are physically located in an urban area, but reclassify to a rural area under 42 CFR 412.103. To determine if a hospital is located in a county that is rural for CMS inpatient prospective payment system (IPPS) wage index purposes, refer to the “FY 2020 “County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File” that is available on the FY 2020 IPPS Final Rule Homepage. Applicants are encouraged to contact their Medicare Administrative Contractor (MAC) to confirm rural status for Medicare GME. Note: if proposing a sustainability plan including Medicare GME funding, all applicants must meet CMS and FORHP’s definition of rural.

2. Federal Office of Rural Health Policy (FORHP) Rural – FORHP accepts all non-metropolitan counties as rural and uses an additional method called the Rural-Urban Commuting Area (RUCA) codes to determine rurality. Census tracts inside Metropolitan counties with the RUCA codes 4-10 are considered rural.10 To determine whether a geographical area is considered rural as determined by FORHP, please use the Rural Health Grants Eligibility Analyzer and the “Am I Rural?” Tools. HRSA’s definition of rural may differ from CMS, which is an important distinction to understand if developing a financial sustainability plan for a rural residency program based on Medicare GME support.

3. Graduate Medical Education Consortium – An association of two or more organizations, hospitals, or institutions involved in residency training, with at least one consortium partner that is a rural training partner. For example, schools of allopathic medicine or osteopathic medicine may be eligible to apply if part of a graduate medical education consortium.

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

10 HRSA Federal Office of Rural Health Policy: https://www.hrsa.gov/rural-health/about-us/definition/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2020-IPPS-Final-Rule-Home-Page https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://www.ruralhealthinfo.org/am-i-rural https://nppes.cms.hhs.gov/ https://www.hrsa.gov/rural-health/about-us/definition/index.html

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5. New Medical Residency Training Program – per 42 CFR 413.79(l), CMS defines a new medical residency program as one that is, “a medical residency that receives initial accreditation by the appropriate accrediting body or begins training residents on or after January 1, 1995”.11

6. Public Health and General Preventive Medicine – ACGME defines Public Health and General Preventive Medicine as the specialty in which physicians focus on health promotion and disease prevention in communities and other defined populations.12

7. Rural Residency Programs – Rural residency programs are ACGME accredited physician residency training programs that place residents in rural training sites for greater than 50 percent of their total time in residency training, and focus on producing physicians who will practice in rural communities.

8. Rural Training Tracks (RTT) – a rural residency program model that consists of partnerships between urban and rural clinical settings where the first year of training occurs within a larger program, typically in an urban hospital or academic medical center, and the final two years occur in a rural health facility. For CMS Medicare GME purposes, RTT programs are separately accredited rural track programs where residents rotate at a rural hospital for more than one-half of the duration of the program. CMS’s regulations for RTT programs are available at 42 CFR 413.79(k).

9. Target Area – A target area is the specific rural geographic location(s) to be served by the proposed rural residency program. If multiple applications are received for the same target area, then only the highest ranked application in the target area will receive consideration for award within available funding ranges. Only one recipient will be funded for a target area.

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

11 CMS’s criteria for determining if a program is new are in the August 27, 2009 Federal Register, page 43908:

http://www.gpo.gov/fdsys/pkg/FR-2009-08-27/html/E9-18663.htm . In determining whether a program is new, CMS will consider the accrediting body’s characterization of the program as new and whether the program existed previously at another hospital, as well as factors such as (but not limited to) whether there are new program directors, new teaching staff, and whether there are only new residents training in the program 12 https://www.acgme.org/Specialties/Overview/pfcatid/20 https://www.ecfr.gov/cgi-bin/text-idx?SID=18471fdd458764a020f9e04%20e55230a38&mc=true&node=pt42.2.413&rgn=div5#se42.2.413_179 https://nppes.cms.hhs.gov/ https://www.acgme.org/Specialties/Overview/pfcatid/20

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11. Clinical – per the definition provided by the ACGME, “clinical” is defined as both direct patient care as well as population health activities.13 Public Health and General Preventive Medicine programs interested in this program should utilize this definition where “clinical” requirements are requested in the application and provide relevant training, experiences, and partnerships in either direct clinical care and/or population health as necessary.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $8,250,000 to be available to fund approximately 11 recipients for the 3-year period of performance. You may apply for a ceiling amount of up to $750,000 total cost for the entire 3-year period of performance (includes both direct costs and indirect costs, facilities and administrative costs). HRSA requires a line item budget and justification for each year of the period of performance.

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

Awards are fully funded at the outset for use over the period of performance.

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

Indirect costs under this program have a maximum rate of 10 percent, if a negotiated cost rate has not been established.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are domestic public or private non-profit entities including domestic faith-based and community-based organizations, tribes, and tribal organizations.

Specifically, these organizations include: 1) rural hospitals, 2) rural community-based ambulatory patient care centers, including federally qualified health centers (FQHC), community mental health centers or rural health clinics, 3) health centers operated by the Indian Health Service, tribe or tribal organization, or an urban Indian organization; 4) graduate medical education consortiums, including schools of allopathic medicine or osteopathic medicine, 5) entities such as faith-based and community-based organizations, capable of carrying out the grant activities.

13 Accreditation Council on Graduate Medical Education: Glossary of Terms. February 14, 2020.

https://www.acgme.org/Portals/0/PDFs/ab_ACGMEglossary.pdf?ver=2020-02-17-152737-483 http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.acgme.org/Portals/0/PDFs/ab_ACGMEglossary.pdf?ver=2020-02-17-152737-483

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Eligible applicants must demonstrate the following to be considered eligible for the RRPD grant program:

Rurality Eligible applicants or the primary rural training partner* must be located in a rural location. For applicants proposing a sustainability plan that relies on Medicare GME funding, the applicant or primary rural training partner must meet both the CMS and FORHP definition of rural. For applicants proposing other sustainability plans, the applicant or primary training partner must meet FORHP's definition of rural. Refer to Section I.2. Program Definitions for more information on rural eligibility. Proof of rural designation is required in Attachment 6.

*In the case of a graduate medical education consortium and other domestic public or private non-profit entity that is located in an urban area, eligible applicants must have a primary training partner located in a rural area. Applicants must submit Letters of Agreement for partnerships and consortiums in Attachment 4.

New Program Applications must propose to develop a newly, accredited residency program in family medicine, internal medicine, preventive medicine, psychiatry, general surgery, or obstetrics and gynecology. Applications requesting funding to expand an existing residency program are not eligible. Entities who have achieved ACGME accreditation for a residency program in the above specialties by the application closing date are not eligible.

Recipients of the RRPD-TA cooperative agreement and the FY2019 RRPD grant (HRSA-19-088) are not eligible to receive funding under this notice.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $750,000 total costs (includes both direct costs and indirect, facilities and administrative costs) for the full period of performance non-responsive and will not consider it for funding under this notice.

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

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Multiple Applications Multiple applications from an organization are not allowable. You may apply for funding to support developing multiple rural residency programs under one award, but you must demonstrate in the application your ability to do so. It is anticipated that most awards will be for one rural residency 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.

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

Program Sustainability Applications must have a clearly defined, factual, and validated sustainability plan that includes ongoing funding stream(s) to sustain resident training once the program is established. Eligible applicants with a sustainability plan that includes Medicare GME payments may also be required to be a rural hospital in accordance with Medicare established regulations 42 CFR 412.64(b)(ii)(C). See Section IV.2.ii. Program Sustainability for more information on sustainability options.

Note: All applications proposing a sustainability plan involving Medicare GME must meet both the CMS and FORHP definition of rural. Refer to Section I.2. Program Definitions for more information on rural eligibility. If any application does not include a clearly defined, factual, and validated sustainability plan or if the application does not include clear, factual, and validated evidence that the applicant organization has ensured that all necessary components of their proposal meet all applicable definitions of rural, that application will be considered incomplete, non-responsive, and therefore ineligible for review.

Notifying your State Office of Rural Health You are required to notify the State Office of Rural Health (SORH) of your intent to apply to this program. A list of the SORHs can be accessed at https://nosorh.org/ nosorhmembers/nosorh-members-browse-by-state/. You must include in Attachment 8 a copy of the letter or email sent to the SORH and any response received to the letter that was submitted to the SORH describing your project.

Each state has a SORH, and HRSA recommends making every effort to contact the SORH entity early in the application process to advise them of your intent to apply. The SORH may be able to provide some consultation to you regarding model programs, data resources, and technical assistance for consortiums, evaluation, partner organizations, or support of information dissemination activities. If you do not receive a response, please include the original letter of intent requesting the support.

https://nosorh.org/%20nosorhmembers/nosorh-members-browse-by-state/ https://nosorh.org/%20nosorhmembers/nosorh-members-browse-by-state/

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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 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must 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. 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 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the 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 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the 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 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, biographical sketches and Letters of Agreement and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-20-107, it may count against the page limit. Therefore, we strongly recommend you 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. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit.

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

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

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Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify, on behalf of the applicant organization, 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 9: Other Relevant Documents.

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

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, 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 Application Guide. In addition to the SF-424 Application Guide requirements, the project abstract must include the following information below. The project abstract must be single-spaced and no more than two pages in length.

Abstract Heading Content:

Applicant Name Eligible Entity Type Project Director Contact Information Residency Program Director Contact Information Residency Type (e.g., rural residency, 1+2 RTT) Residency Specialty Sponsoring Institution Rural Target Area(s) Funding Amount Requested Program Sustainability Option (refer to Section IV.2.ii. Program Sustainability for further details) Projected Number of Residents; and Expected ACGME Accreditation and Residency Matriculation Dates

Abstract Body Content:

Brief overview of the project including description of geographic area (e.g., rural counties served), target patient population and needs, consortium partners (if applicable) and clinical partnerships (e.g., clinical sites that are FQHCs, Veteran Affairs clinical sites); and

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Specific measurable objectives and expected outcomes of the project, 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). Please also include a listing of recent HRSA awards received relevant to the project (e.g., health workforce, rural, or training awards).

ii. Project Narrative

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

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

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 “Purpose and

Need”

Briefly describe the purpose of the proposed project and clearly identify specific project goals, objectives, and expected outcomes. Summarize how the proposed project will address the population health needs and expansion of family medicine, internal medicine, preventive medicine, psychiatry, general surgery, or obstetrics and gynecology care and access for the proposed target area(s).

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 “Purpose and Need”

Provide an overview of the health workforce and health care needs of the target area(s) served by the proposed project. This section should primarily focus on describing the needs of the community, the organization and facility(s) needs to develop a new rural residency program, and an assessment of the current health care infrastructure, including the graduate medical education landscape and other residency programs serving the community. You must use and cite demographic data (e.g., local, state, federal) whenever possible to support the information provided.

Specifically, this section must include the following information:

1) Description of the geographic area in which the residency program is located, and the impact on this need to the areas that your residency program is working to solve. To the extent possible, include data on the population demographics, social determinants of health, health disparities faced by, and health care needs of the population served, barriers to access and care, and any other unmet needs. Indicate the presence of Medically Underserved Communities (MUC) and/or Health Professional Shortage Areas (HPSA).

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2) Shortages and need for additional physicians in the specialty for which you are applying for funding, including current (within 3 years) information and data demonstrating needs for the proposed specialty in the target area(s) and identify specific reasons for this shortage.

3) Description of the rural health care delivery system and the specific needs of the facility(s) hosting the rural residency program. Include information on the organization’s structure and the clinical and faculty capacity needed to support a new rural residency program.

4) Description of any residency programs (existing or in development) in the specialty area for which you are applying for funding, that serves the target area(s) where the proposed new rural residency program will be located.

5) Description of any progress that has already been made towards developing a rural residency program.

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

7) Description of any consultations with the State Office of Rural Health related to the planning and development of the new rural residency program.

The following section below corresponds to Section V’s Review Criterion #2 “Response” which includes three sub-sections – (a) Methodology, (b) Work Plan, and (c) Resolution of Challenges.

METHODOLOGY -- Corresponds to Section V’s Review Criterion #2(a) “Response”

Propose methods that will be used to address the stated needs and how they will achieve identified program goals and objectives. Clearly specify how the proposed methods will overcome challenges and barriers identified in the “Needs Assessment” section above. Specifically, this section must include how you plan to achieve:

1) ACGME accreditation for the new rural residency program no later than the end of the program performance period (i.e., July 31, 2023). Applicants must describe:

a. Clinical capacity to meet ACGME accreditation requirements including sufficient numbers of dedicated, supervisory faculty, adequate patient care volume, and appropriate resident training time in relevant medical specialties and subspecialties. Note: This may be achieved through clinical training partnerships. In this case, Letters of Agreement must be submitted in Attachment 4.

b. Current organizational structure and plan to meet ACGME requirements, including governance structure and the capacity of the organization to meet ACGME sponsoring institution requirements.

https://www.ruralhealthinfo.org/organizations/state-office-of-rural-health

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This may also include acquiring access to electronic health records, library services, learning management systems, etc.

c. Faculty recruitment and development plan to support residency program, including recruiting specialty faculty to meet ACGME requirements for the proposed specialty.

d. Curriculum and training plan, including incorporation of interprofessional training and development, culturally and linguistically appropriate care and training to address the health needs and disparities of patients from the proposed target areas(s).

The curriculum plan should be high quality, leading to successful board certification of graduates and readiness for clinical practice following completion of training.

2) Resident matriculation no later than the AY immediately following the end of the program period of performance (i.e., Fall 2024). Applicant must describe a plan to:

a. Recruit and support a diverse cohort of high quality residents, including outreach to medical students with a rural background.

b. Recruit and train at least the minimum number of residents required to achieve and maintain accreditation for the proposed specialty.

c. Promote retention of resident graduates to practice in rural

3) Tracking residents’ career outcomes for a period of at least 5 years post-graduation from the rural residency program. Applicants must describe a plan to:

a. Develop a tracking tool/mechanism or leverage an existing graduate tracking system to track and publicly report on graduates career outcomes and retention in rural and underserved areas, including but not limited to, practice specialty/sub-specialty and location. At a minimum, the graduate tracking plan should be equipped with the ability to accurately collect the following graduate outcomes:

i. National Provider Identifier (NPI)

ii. Practice location(s)

iii. Specialty Area

iv. Part-time or full-time practice status

b. Track other practice characteristics and graduates demographics.

Note: Award recipients should consider adding the performance measures related to accredited positions, admissions, and enrollees by year of training, by age, gender, race, ethnicity, location of training, new curriculum development, and faculty development and intent to be employed in rural areas, to the plan for tracking characteristics of practice and graduates. Award recipients that initiate their programs during the period of performance may be requested to report on selected characteristics of enrollees and graduates. Refer to https://bhw.hrsa.gov/grants /reportonyourgrant for examples of performance data.

https://bhw.hrsa.gov/grants/reportonyourgrant

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Additionally, applicants should include innovative approaches or any unique characteristics of the program that would enhance the quality of residency training and address the stated needs of the targeted rural area(s), such as:

• Emerging patient care or health care delivery strategies (e.g., patient centered medical homes, telehealth etc.)

• Integration of interprofessional education and practice

• Integration of oral health and/or mental health and substance use disorder treatment

WORK PLAN -- Corresponds to Section V’s Review Criterion #2(b) “Response”

Provide a clear and coherent work plan describing the process to achieve each of the program goals/objectives in Attachment 1. A sample work plan can be found here at https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf.

The work plan must clearly describe:

1) Activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the “Methodology” section;

2) Timeframes, deliverables and identify key faculty, staff and partners responsible for executing on each activity during the RRPD award period of performance;

3) Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation;

4) 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

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

Note: A complete staffing plan and job descriptions for key personnel must be submitted in Attachment 2. Letters of Agreement for key stakeholders involved in the work plan must be submitted in Attachment 4 and/or Attachment 7 (related to program sustainability).

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2(c) “Response”

Rural residency programs face unique challenges and barriers not experienced by their urban counterparts. Common challenges often include lacking sufficient community-based specialty and subspecialty preceptors willing to sponsor residents for educational/clinical rotations, or ensuring residents will encounter a sufficient patient volume required for accreditation.

https://bhw.hrsa.gov/sites/default/files/bhw/grants/workplantemplate.pdf

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Discuss barriers and challenges likely to be encountered planning and developing a new rural residency program. Specifically, applicants must address the following:

1) Highlight any roadblocks you are likely to encounter in implementing activities described in the work plan and approaches that you will use to resolve these challenges.

2) Describe any additional challenges both internal and external to your organization, including key stakeholders (e.g., Sponsoring Institution, clinical training sites, etc.), that may directly or indirectly affect development of the program. Discuss how these challenges will be resolved.

3) Describe challenges and resolutions to incorporating interprofessional health care and innovative approaches and recruiting a diverse cohort of high quality residents.

Note: Applicants are encouraged to utilize the RRPD-TA center resources and webinars available at www.ruralgme.org to address barriers and challenges during the application phase.

The following section below corresponds to Section V’s Review Criterion #3 “Impact” which includes two sub-sections – (a) Evaluation and Technical Support Capacity and (b) Program Sustainability.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion #3(a) “Impact”

Describe the plan for program performance evaluation that will meet ACGME accreditation requirements and promote continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities.

Describe the systems and processes that will support your organization's performance management requirements through effective tracking of performance outcomes. You must describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

Prior to the end of the period of performance, grant recipients must report on the following outputs. Please provide anticipated values for these outputs in your application:

Number and type (i.e., model and specialty) of newly established rural residency programs Number of residents each rural residency program can support at the onset Number of residents each rural residency program will support once fully established (longer-term goal) Number and type of existing clinical training sites for residents Number and type of newly established clinical training sites for residents http://www.ruralgme.org/

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Number of faculty and staff trained to teach, support and administer the curriculum at each rural residency program site

Number and type of existing partnerships (e.g., non-clinical training site) that support the rural residency program

Number and type of newly established partnerships (e.g., non-clinical training site) that support the rural residency program

By the end of the period of performance, award recipients will be required to submit:

Documentation of ACGME accreditation status and plans for future accreditation review and status maintenance;

Detailed professional certification, training profile, and planned time dedicated to residency supervision and training of rural residency program or RTT leadership (Program Directors/Associate and Assistant Program Directors) and Key Clinical Faculty, in line with the current ACGME accreditation requirements for these positions.

Note: A complete staffing plan and job descriptions for key personnel must be submitted in Attachment 2. Bio sketches of key personnel must also be submitted in Attachment 3.

PROGRAM SUSTAINABILITY -- Corresponds to Section V’s Review Criterion

#3(b) “Impact”

Applicants must propose a clearly defined, fact-based, validated sustainability plan to support the long-term financial sustainability for the new rural residency program beyond the RRPD period of performance. Health care sites sponsoring new rural residency programs through this grant program must additionally have a strong, long-term outlook in regard to their financial stability. The application must speak at least broadly to this institutional financial outlook.

The application must clearly describe a financial sustainability plan for supporting the costs of your rural residency program, including financial investments you have already made, any foreseeable challenges and barriers to your proposed sustainability plan, and how you will address these challenges and barriers. The financial sustainability plan must describe funding sources other than clinical revenue that are available or projected for the long term.