PKG00264511-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Primary Care Training and Enhancement-Community Prevention and

Maternal Health (PCTE-CPMH)

Funding Opportunity Number: HRSA-21-014 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.884

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: February 22, 2021

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: December 14, 2020

Program Contact Name: Irene Sandvold, DrPH, FACNM, FAAN Project Officer, Bureau of Heath Workforce Telephone: (301) 443-2295 Fax: (301) 443-0162 Email: isandvold@hrsa.gov

Authority: 42 U.S.C. § 293k(a) (Section 747(a) of the Public Health Service Act) http://www.hrsa.gov/grants/apply/write-strong/

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Primary Care Training and Enhancement-Community Prevention and Maternal Health (PCTE-CPMH) Program. The purpose of this program is to train primary care physicians in maternal health care clinical services or population health in order to improve maternal health outcomes. The program will increase the number of primary care physicians trained in public health and general preventive medicine with maternal health care expertise and the number of primary care physicians trained in enhanced obstetrical care practicing in rural and/or underserved areas.

There are two training tracks: Primary Care Community Prevention Track and Primary Care Obstetrics Track. Both tracks train primary care physicians in different aspects of maternal health care.

Primary Care Community Prevention Track: The Primary Care Community Prevention Track supports training for either (1) primary care physicians (defined as physicians who have completed residency and are board-eligible or board-certified in family medicine, general internal medicine, general pediatrics, or combined internal medicine and pediatrics) and that are training in the second specialty of public health and general preventive medicine (hereafter referred to as “preventive medicine”), or (2) resident physicians in combined internal medicine-preventive medicine or family medicine-preventive medicine residency programs. The aim of this track is specifically to broaden residents’ scope of services in community prevention and maternal health care. The program will also contribute to the integration of public health into primary care in rural and/or underserved areas.

Rotational experiences created by awardees for this track can be made available to other physicians in training as well, but non-primary care physicians may not be supported by this award.

Primary Care Obstetrics Track: The Primary Care Obstetrics Track supports training for either (1) primary care physicians (defined as physicians who have completed residency and are board-eligible or board-certified in family medicine) that are training in an obstetrics fellowship program, or (2) resident physicians in family medicine residency programs with enhanced obstetrical training, including training which is provided by a co-located obstetrics-gynecology residency program.

The aim of this track is specifically to broaden the training and scope of practice of these physicians to provide high quality, evidence-based maternity care services in rural and/or underserved areas, including physiologic vaginal birth and cesarean sections. Rotational experiences created by awardees for this track can be made available to other physicians in training as well, but non-primary care physicians may not be supported by this award.

Applicants for both training tracks are encouraged to engage in partnerships with state Title V Maternal and Child Health Services Block Grant Programs. Title V programs are a key source of support for promoting and improving the health and well-being of the nation’s mothers, children, including children with special needs, and their families. These

HRSA-21-014 ii programs have the data to help target needs and monitor the maternal health workforce within their states.

The FY 2021 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

You should note that this program may be cancelled prior to award.

Funding Opportunity Title: Primary Care Training and Enhancement-

Community Prevention and Maternal Health Program

Funding Opportunity Number: HRSA-21-014

Due Date for Applications: February 22, 2021 Anticipated Total Annual Available FY 2021 Funding:

$15,783,000

Estimated Number and Type of Award(s):

Approximately 26 grants

Estimated Award Amount: Up to $600,000 per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No Period of Performance: July 1, 2021 through June 30, 2026 (5 years) Eligible Applicants: Eligible entities for the PCTE-CPMH program are an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such a grant. See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

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

Technical Assistance HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions. Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PROGRAM 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. Standardized Work Plan (SWP) Form

vi. Attachments

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

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

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

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I. Program Funding Opportunity Description

This notice announces the opportunity to apply for funding under the Primary Care Training and Enhancement-Community Prevention and Maternal Health (PCTE-CPMH) Program.

1. Program Purpose The purpose of this program is to train primary care physicians in maternal health care clinical services or population health in order to improve maternal health outcomes. The program will increase the number of primary care physicians trained in public health and general preventive medicine, or trained in enhanced obstetrical care to increase maternal health care expertise and the number of primary care physicians trained in enhanced obstetric care in rural and/or underserved areas.

There are two training tracks: Primary Care Community Prevention Track and Primary Care Obstetrics Track. Both tracks train primary care physicians in different aspects of maternal health care.

Primary Care Community Prevention Track: The Primary Care Community Prevention Track supports training for either (1) primary care physicians (defined as physicians who have completed residency and are board-eligible or board-certified in family medicine, general internal medicine, general pediatrics, or combined internal medicine and pediatrics) and that are training in the second specialty of public health and general preventive medicine (hereafter referred to as “preventive medicine”), or (2) resident physicians in combined internal medicine-preventive medicine or family medicine-preventive medicine residency programs. The aim of this track is specifically to broaden residents’ scope of services in community prevention and maternal health care. The program will also contribute to the integration of public health into primary care in rural and/or underserved areas. Rotational experiences created by awardees for this track can be made available to other physicians in training as well, but non-primary care physicians may not be supported by this award.

Primary Care Obstetrics Track: The Primary Care Obstetrics Track supports training for either (1) primary care physicians (defined as physicians who have completed residency and are board-eligible or board-certified in family medicine) that are training in an obstetrics fellowship program, or (2) resident physicians in family medicine residency programs with enhanced obstetrical training, including training which is provided by a co-located obstetrics-gynecology residency program. The aim of this track is specifically to broaden the training and scope of practice of these physicians to provide high quality, evidence-based maternity care services in rural and/or underserved areas, including physiologic vaginal birth and cesarean sections. Rotational experiences created by awardees for this track can be made available to other physicians in training as well, but non-primary care physicians may not be supported by this award.

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Applicants for both training tracks are encouraged to engage in partnerships with state Title V Maternal and Child Health Services Block Grant Programs. Title V programs are a key source of support for promoting and improving the health and well-being of the nation’s mothers, children, including children with special needs, and their families.

These programs have the data to help target needs and monitor the maternal health workforce within their states.

Program Goals The goal of PCTE-CPMH Program is to increase the number of primary care physicians trained in population health with a focus on maternal health outcomes and increase the number of primary care physicians trained to provide high quality obstetrical care in rural and/or underserved areas.

Program Objectives

1. Develop partnerships between academia, primary care delivery sites or systems, and community-based organizations to carry out education and training programs for primary care physicians who desire additional competencies and experiences in community prevention and obstetrics.

2. Educate and train family medicine residents and fellows in obstetrics care, to broaden their training and scope of practice in providing evidence-based maternity care services.

3. Educate and train primary care residents (who are board-eligible or board-certified in family medicine, general internal medicine, general pediatrics, or combined internal medicine and pediatrics or enrolled in a combined primary care and preventive medicine program) to broaden their scope of services in community prevention and maternal health care.

4. Demonstrate how outcomes in maternal health can be improved through adoption of community prevention training as well as through obstetrics clinical training in primary care training and practice.

HHS and HRSA Priorities

This NOFO addresses training to enhance competencies in maternal health for primary care providers to transform the workforce, target the need and prevent and reduce maternal mortality. You are encouraged to select and address additional HHS and HRSA clinical priorities below.

• Ending the crisis of opioid addiction and overdose in America

• Improving mental health access and care

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

• Strengthening health care access through telehealth

• Ending the HIV epidemic

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2. Background

This program is authorized by 42 U.S.C. § 293k(a) (Section 747(a) of the Public Health Service (PHS) Act). The HRSA PCTE-CPMH program seeks to prevent and reduce maternal mortality and severe maternal morbidity in rural and/or underserved areas by training primary care providers in clinical obstetrics and preventive medicine with a focus on maternal health.

An estimated 60 percent of pregnancy related deaths are preventable.1 Nearly 50 percent of all pregnancy-related deaths from review of nine maternity mortality review committees were caused by hemorrhage, cardiovascular and coronary conditions, cardiomyopathy or infections.2 Residents in the Primary Care Community Prevention Track will learn from and provide leadership in strengthening maternal mortality review committees. These standardized committees contribute to understanding causes and implementing solutions to improve maternal health outcomes. The residents in the Primary Care Obstetrics Track increase skills on managing and preventing these conditions. Findings from mortality reviews provide guidance to the curriculum for the obstetrics training track and for changes in the delivery system.

The rate of pregnancy-related deaths during or within one year of pregnancy in the U.S. has steadily increased from 7.2 deaths per 100,000 live births in 1987 to 16.9 per 100,000 live births in 2016 (the latest available year of data).3 Many women living in rural areas of the U.S. are geographically isolated with limited access to quality obstetrical services.4 Forty-five percent of U. S. counties had no hospital system from 2004-2014 and another nine percent of rural counties lost all hospital obstetrical services during that time.5 Women in these rural counties with fewer medical providers have a higher percentage of African American and lower income residents and are

1 Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrieved from http://reviewtoaction.org/Report_from_Nine_MMRCs 5/21/2020.

2 IBID

3 Data are from the CDC PMSS that includes death certificates for all women who died during pregnancy or within one year of pregnancy and matching birth or fetal death certificates. Pregnancy-related deaths are defined as the death of a woman while pregnant or within one year of the end of a pregnancy –regardless of the outcome, duration or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

This definition extends the World Health Organization definition of maternal deaths from within 42 days to within one year of pregnancy. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

4 Hung, P., Henning-Smith, C., Casey, M., and Kozhimannil, K. “Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004–14.” Health Affairs 36, No. 9 (2017).

5 Hung, P., Henning-Smith, C., Casey, M., and Kozhimannil, K. “Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004–14.” Health Affairs 36, No. 9 (2017).

American College of Obstetrics and Gynecology, Committee on Obstetric Practicce, Number 736 Presidencial Task Force on Redefining the Postpartum Visit, Redefining the Postpartum Visit, Increasing Engagement https://www.acog.org/clinical/clinical-guidance/committee-opinion/optimizing-postpartum-care accessed May 21, 2020.

http://reviewtoaction.org/Report_from_Nine_MMRCs https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm https://www.acog.org/clinical/clinical-guidance/committee-opinion/optimizing-postpartum-care https://www.acog.org/clinical/clinical-guidance/committee-opinion/optimizing-postpartum-care

HRSA-21-014 4

more likely to lack access to hospital obstetrical services.6 The lack of access can mean life or death if a woman experiences complications such as hemorrhage or hypertension after returning home from delivery. 6

Several policy and stakeholder groups emphasize the importance of training primary care physicians both in clinical maternal health and public health in order to address the problems of disparities and increased mortality and morbidity. The members of the Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD), in their January 8-9, 2020 meeting for their 18th report on “Rural Health”, recommended that HRSA address maternal health through “support for educational and training programs that promote evidence-based maternal care in rural settings”.7

Several national bodies, including the Institute of Medicine, the Robert Wood Johnson Foundation, and the American Academy of Family Practice, have called for an integration of public health into primary care.8,9,10

The literature demonstrates the need for expanded training in obstetrics in order to increase the number of physicians who are competent to manage maternal health care working in rural and underserved areas. Family physicians fill the gap in providing maternity care services in many rural and some underserved areas.11 The proposed Primary Care Obstetrics Track is not training in the medical specialty of obstetrics and gynecology, although some fellowships are referred to as “obstetrics fellowships” by the medical community. Rather, this training is an extension of the Accreditation Council on Graduate Medical Education (ACGME) required Family Medicine residency core requirements in the care of women, including provision of prenatal, intrapartum and postpartum care, participation in deliveries, labor management, delivery management, and care between pregnancies. These residency and fellowship requirements are designed to train physicians to provide maternity care, including distinguishing abnormal and normal pregnancies; caring for common medical problems arising from pregnancy or coexisting with pregnancy; performing a spontaneous vaginal delivery; and managing obstetrical emergencies. Family Medicine physicians

6 https://www.hrsa.gov/sites/default/files/ourstories/mchb75th/mchb75maternalmortality.pdf.

7 Advisory Committee on Primary Care Medicine and Dentistry (ACPCMD) meeting minutes Jan.8-9, 2020.

8 Linde-Feucht S, Coulouris N. Integrating Primary Care and Public Health: a Strategic Priority. American

Journal of Public Health. 2012 June;102 Suppl 3:S310-1. doi: 10.2105/AJPH.2012.300849.

9American Academy of Family Practice Integration of Primary Care and Public Health. Position Paper.

https://www.aafp.org/about/policies/all/integprimarycareandpublichealth.html.

10 Taylor E et al. Integrating Public Health and Health Care: Getting Beyond the Theory. Robert Wood

Johnson Foundation. https://www.shvs.org/wp-content/uploads/2016/03/SHVS-Bailit-Public-Health- Integration-March-2016.pdf.

11 Aimee R. Eden, Lars E. Peterson, Challenges Faced by Family Physicians Providing Advanced Maternity

Care. Maternal and Child health Journal. 2018; 22:932-940.

https://link.springer.com/article/10.1007%2Fs10995-018-2469-2.

https://www.aafp.org/about/policies/all/integprimarycareandpublichealth.html https://www.shvs.org/wp-content/uploads/2016/03/SHVS-Bailit-Public-Health-Integration-March-2016.pdf https://www.shvs.org/wp-content/uploads/2016/03/SHVS-Bailit-Public-Health-Integration-March-2016.pdf https://link.springer.com/article/10.1007%2Fs10995-018-2469-2

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who receive this training will gain competencies in ultrasound, colposcopy, and other obstetrical procedures essential for managing care. They will also gain experience with collaborative management of care with the rest of the maternity care team serving in rural and underserved areas. This will be key in avoiding burnout for the family medicine physicians and enhance the wrap-around services provided to women and families.

The Technical Report from the HRSA Maternal Mortality Summit, “Promising Global Practices to Improve Maternal Health Outcomes,” provides key findings for action.12.

This NOFO addresses several of the summit’s key findings by providing support for residents to focus on the maternal health population and for the expansion of education for family medicine residents and family medicine physicians on clinical maternity care, in the context of team-based care. The PCTE-CPMH program also supports the clinical experiences to enable graduates or program completers to develop competencies and confidence to manage maternal health care for underserved and rural women and their families.

Indicators of a successful project for the Primary Care Community Prevention Track are an increased number of primary care physicians trained in preventive medicine who provide leadership in maternal health programs, improved linkages between the local and state health departments and community health centers (CHCs) on solutions to improve maternal health, and better means for addressing disparities in maternal health outcomes. Successful projects for the Primary Care Obstetrics Track are programs with an increased number of primary care physicians trained to incorporate high quality obstetrical care in their family medicine practice in rural and underserved areas.

Additional information on the Bureau of Health Workforce programs can be found at www.hrsa.gov/bhw.

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. In addition, the following definitions apply to the PCTE-CPMH Program for Fiscal Year 2021:

Community-based organization means a public or private nonprofit entity that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety community needs.

12 Department of Health and Human Services, Health Resources and Services Administration, HRSA Maternal Mortality Summit: Promising Global Practices to improve Maternal Health Outcomes, February 15, 2019.

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Community Health Center for purposes of this NOFO is a not-for-profit or federally-funded, consumer directed healthcare organization that provides access to high quality, affordable, and comprehensive primary and preventive care. Some of the centers offer medical, dental, and mental health care on site or through a contract with another organization. Community health centers have a unique mission of ensuring access for undeserved, under-insured and uninsured patients.

Longitudinal clinical training experience means a long term (e.g., 3 months or longer) clinical experience with a clinical partner, focusing on the care of tribal communities, rural communities, and/or medically underserved communities (MUCs).

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/#/.

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

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

Title V Maternal and Child Health Services Block Grant Programs are one of the largest federal block grant programs awarded to States and jurisdictions. Title V is a key source of support for promoting and improving the health and well-being of the nation’s mothers, children, including children with special needs, and their families.

State Title V contacts are available here:

https://mchb.tvisdata.hrsa.gov/Home/StateContacts

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.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf#/ https://mchb.hrsa.gov/maternal-child-health-initiatives/title-v-maternal-and-child-health-services-block-grant-program https://mchb.tvisdata.hrsa.gov/Home/StateContacts

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2. Summary of Funding

HRSA estimates approximately $15,783,000,000 to be available annually to fund approximately 26 recipients. The actual amount available will not be determined until enactment of the final FY 2021 federal appropriation. You may apply for a ceiling amount of up to $600,000 total cost (includes both direct and indirect) per year.

The FY 2021 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately.

The period of performance is July 1, 2021 through June 30, 2026 (five years).

Funding beyond the first year is subject to the availability of appropriated funds for the PCTE-CPMH Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the federal government. HRSA may reduce funding levels beyond the first year if the recipient is unable to fully succeed in achieving the goals listed in the application.

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

Limitations on indirect cost rates

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

III. Eligibility Information

1. Eligible applicants

Eligible entities for the PCTE-CPMH program are an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such a grant.

Faith-based and community-based organizations are eligible to apply for these funds if otherwise eligible. Tribes and tribal organizations may apply for these funds, if otherwise eligible.

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

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2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Accreditation Applicants must provide documentation of accreditation, consistent with the training tracks addressed in the application, by the ACGME as Attachment 10.

Documentation must include (1) a statement that you hold continuing accreditation from the relevant accrediting body and are not under probation, (2) the dates of initial accreditation and next accrediting body review, (3) the accreditation start and expiration dates, and (4) a web link to the accreditation status. The full letter of accreditation is not required. Failure to submit the required accreditation documentation may be considered by HRSA as non-responsive and ineligible for consideration. Applicants are required to maintain their accreditation or state approval status throughout the period of performance and notify HRSA of change in status.

Ceiling Amount HRSA will consider any application that exceeds the ceiling of $600,000 per year (direct and indirect costs) for each year of the 5-year project period non-responsive and will not consider it for funding under this notice.

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

Maintenance of Effort (MOE) The recipient must agree to maintain expenditures of non-federal funding for award activities at a level that is not less than the level of expenditures for such activities for the fiscal year preceding the fiscal year for which the entity receives the award, as required by 42 U.S.C. § 295n-2. Complete the Maintenance of Effort information in the chart provided and submit as Attachment 6. HRSA will consider any application that fails to satisfy the requirement to provide MOE information non-responsive and will not consider it for funding under this notice.

Multiple Applications Multiple applications from an organization with the same DUNS number or Unique Entity Identifier (UIE) are allowable if the applications propose separate and distinct projects.

An institution may submit a separate application for both the Primary Care Community Prevention Track and the Primary Care Obstetrics Track. Each

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application must note on the SF-424 R&R cover sheet whether it is for the Primary Care Community Prevention Track or the Primary Care Obstetrics Track.

If an institution is applying for both training tracks, the project director must be different for each track and meet the qualifications as defined in Funding Restrictions, Project Director.

For each of the two applications, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number and designated training track, 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 and may not be considered for funding under this notice.

Beneficiary Eligibility A resident or fellow receiving support from grant funds must be a citizen, national, or permanent resident of the United States.

IV. Application and Submission Information

1. Address to Request Application Package

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

The NOFO is also known as “Instructions” on Grants.gov. You must 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 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific mailto:kross@hrsa.gov http://sam.gov/ http://sam.gov/ https://www.grants.gov/web/grants/applicants.html https://www.hrsa.gov/sites/default/files/hrsa/ruralhealth/resources/telehealth/2018Directory.pdf

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information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. Yu 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 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-014, 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. 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.

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 13 Other Relevant Documents.

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

https://telehealth.hhs.gov/

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Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction.

Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via https://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

Program-Specific Instructions

Program Requirements

Primary Care Community Prevention Track

Applicants to the Primary Care Community Prevention Track must be accredited by the Accreditation Council for Graduate Medical Education (ACGME) and be either (1) free-standing Public Health and General Preventive Medicine residency programs or (2) combined residencies of Public Health and General Preventive Medicine with either internal medicine or family medicine.

Programs must:

1. Provide residents with a minimum 3-month rotation (longitudinal or cumulative) that focuses on maternal health programs and community maternal health needs at a local or state health department or community health center in rural and/or underserved communities.

2. Provide residents with appropriate mentorship and faculty guidance to complete at least one scholarly project that addresses factors affecting maternal health and well-being, and report on projects in the annual progress report to HRSA.

3. Provide resident experience with maternal mortality review committee (MMRC) work by participating in or leading the MMRC.

4. Provide residents with leadership opportunities in engaging community organizations and sectors related to maternal health to design solutions for solving disparities in maternal health outcomes of severe morbidity and mortality.

5. Incorporate interprofessional learning experiences, both in the didactic content and in experiential learning.

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Primary Care Obstetrics Track Applicants to the Primary Care Obstetrics Track must be either (1) an existing obstetrics fellowship program affiliated with either an ACGME-accredited program in family medicine or an ACGME-accredited residency program that is housed within a Department of Obstetrics and Gynecology (OB/GYN), or (2) an ACGME-accredited Family Medicine residency program with an existing expanded obstetrics curricular component.

Programs must:

1. Provide guided clinical experience in: the provision of prenatal, postpartum care; participation in and management of physiological and cesarean section deliveries; labor management; interconceptional care; distinguishing abnormal and normal pregnancies; caring for common medical problems arising from pregnancies or co-existing with pregnancy; performing a spontaneous vaginal delivery; managing obstetrical emergencies; and competencies in specific procedures for pregnancy management such as ultrasound, colposcopy, and other obstetrical procedures essential for managing care.

2. Provide experience with collaborative management of care with the rest of maternity care team serving in rural and/or underserved areas including nurses, nurse-midwives, doulas, social workers, allied health professionals, and other health care workers.

3. Provide the opportunity for residents to gain competence in performing cesarean sections.

4. Provide training at institutions that have a sufficient volume of services for a minimum of 20 cesarean sections, at risk pregnancies, and deliveries per resident or fellow. The institution may collaborate with other high volume facilities in order for residents and fellows to gain this level of experience.

5. Incorporate interprofessional learning experiences, both in the didactic content and in experiential learning, including collaboration with midwives, nurses, and doulas.

6. Residents or fellows must have at least one month of rotation in a rural and/or underserved hospital with obstetrical services or a rural and/or underserved free standing birth center.

Requirements for both training tracks

1. Provide clinical experiences for residents in the use of telehealth technology to improve access to health services and improve maternal health outcomes.

Refer to telehealth resources at the end of the NOFO.

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

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3. Develop a plan to collect post-graduation employment demographics of graduates and completers from residency and fellowship training tracks for one year after they complete their residency or fellowship.

4. Ensure residents apply for a NPI number and collect the NPI numbers of residents and fellows who participate in the program.

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. Select one training track:

o Primary Care Community Prevention Track o Primary Care Obstetrics Track; and

6. If applicable, provide a statement requesting the priority and/or preference and the basis for the request.

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:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

This section will help reviewers understand the organization that would receive funding for training as well as the needs of the areas that residents and fellows would ultimately serve.

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

1. Identify the training track addressed by the application.

2. Shortages and need for primary care physicians trained in obstetrics care or preventive medicine capable of improving maternal health outcomes in the locality or in which the residency or fellowship training is located, especially in rural and/or underserved areas.

3. Data on demographics, social determinants of health and health disparities faced by the population served and their maternal health needs, including prevention and treatment of risk factors such as diabetes, heart disease, hypertension, obesity, depression, OUD and SUD in pregnancy in with a focus on rural and/or underserved areas.

4. Gaps in the obstetrics services and preventive medicine maternal health surveillance outcomes including resources available to care for individuals and families experiencing OUD and SUD in the area served by the program.

5. Gaps in the telehealth capacity including equipment, technical support, its use in education and providing services especially maternal health to rural and/or underserved populations.

6. Characteristics of existing program partners that align with the project purpose and the need for strengthening academic and community linkages with state and local health departments, community health centers, and other community providers for development of maternal health clinical training sites for residents or fellows.

7. Need for providers, preceptors, and faculty with the skills addressed in this NOFO in the sites where the residents or fellows will train.

8. Type of training sites and for Primary Care Obstetrics Track programs, number of vaginal deliveries and C-sections.

9. Type of interprofessional experiences available for the Primary Care Community Prevention Track in the public health and community health center settings.

10. Interprofessional education and services for learning experiences.

11. Range of services in the clinical training sites including ambulatory care for maternal health in the locality of the program.

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RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections — (a) Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

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

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope. Your work plan must be submitted through the Standardized Work Plan (SWP) Form. The SWP form is organized by budget period and must include all activities and deliverables for each objective and program goal. Objectives may be categorized by organizational priorities by selecting applicable priorities on the SWP form. Form instructions are provided along with the SWP form, and are included in the application package found on Grants.gov.

1. Identify the objectives and sub objectives for the project to provide the framework for activities for each year of the project (specific, measureable, achievable, realistic and time framed).

2. Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section for each year of the project period.

3. Describe the timeframes, deliverables, and key partners required during the five-year project period of performance to address each of the activities designed to address the needs described in the Purpose and Need section. Identify the persons responsible for each activity.

4. Provide the implementation timeline for the project period throughout the five-year period of performance.

5. Identify support and collaboration with key stakeholders, including state and local health departments, community health centers, and other community providers in planning, designing and implementing all activities, including development of the application; and the extent to which these contributors reflect the populations and communities served.

6. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly used and monitored.

7. Describe the plan for actions to recruit and admit residents or fellows and to retain them to graduation or program completion. Provide projected number of residents and fellows. Provide actions to be taken to mandate participants to acquire NPI numbers.

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You must complete the Standardized Work Plan (SWP) mandatory form in the Application Package.

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

Criterion #2 (b).

1. Describe your overall objectives (specific, measureable, achievable, realistic, and time framed) and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO.

2. Describe how you plan to develop effective tools and strategies for ongoing faculty development, preceptor training, outreach, collaborations, and clear lines of communication.

3. Describe a plan for engaging the community in making decisions on the program and identifying their priority needs and solutions for reducing severe maternal morbidity and mortality with efforts to involve patients, families, and communities.

4. Describe a plan to disseminate reports, products, and/or project outputs so project information is provided to key audiences. Explain why your project is innovative and provide the context for the project’s innovation.

5. Provide a training chart with projected number of residents or fellows to be admitted and graduated from the program for each level of the program and each year of the project.

6. Provide a one page logic model appropriate for designing and managing the project that includes objectives, activities, and short, intermediate and long term outcomes and attach as Attachment 8.

Logic Model

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

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

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

• Inputs (e.g., organizational profile, collaborative partners, key

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personnel, budget, other resources);

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

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

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

and

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

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. You can find additional information on developing logic models at the following website:

http://www.acf.hhs.gov/sites/default/files/fysb/prep-logic-model-ts.pdf.

(c) Resolution of Challenges -- Corresponds to Section V’s Review Criterion

#2 (c)

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan,…