U.S. Department of Health and Human Services

U.s. department of health and human services

Health Resources and Services Administration

Bureau of Health Professions

Division of Medicine and Dentistry

Teaching Health Center

Graduate Medical Education (THCGME) Program

Announcement Type: New

Announcement Number: HRSA 12-029

Catalog of Federal Domestic Assistance (CFDA) No. 93.530

FUNDING OPPORTUNITY ANNOUNCEMENT

Fiscal Year 2012

Application Due Date: October 11, 2011

Ensure your Grants.gov registration and passwords are current immediately!!

Deadline extensions are not granted for lack of registration.

Registration can take up to one month to complete.

Release Date: September 6, 2011

Issuance Date: September 6, 2011

Program Contact Name:

Songhai Barclift, MD

Chief, Community Based Training Branch

Division of Medicine and Dentistry/BHPr/HRSA

E-mail:

Telephone: (301) 443-8681

Authority: Section 340H of the Public Health Service Act, as added by Section 5508 of the Patient Protection and Affordable Care Act of 2010 (P. L. 111-148)

Executive Summary

Teaching Health Centers (THC) operate medical and dental residency training programs to educate primary care providers in community-based ambulatory patient care settings. Although THCs are not limited to federally qualified health centers (FQHC), evidence has shown that resident physicians who train in Health Center (HC) settings are nearly three times as likely to practice in underserved settings after graduation. They are 3.4 times as likely to work in a HC, when compared to residents who did not train in HCs. Successful THCs have a dual mission of service and education, alignment of funding to support both patient care and training, and an organizational structure that supports the complexity of operating both a HC and a residency training program.

This announcement solicits applications for Fiscal Year (FY) 2012 for the Teaching Health Center Graduate Medical Education program. This is a $230 million, five-year initiative which began in 2011 to support an increased number of primary care residents and dentists trained in community-based ambulatory patient care settings. These community-based settings include federally-qualified health centers, community mental health centers, rural health clinics and health centers operated by the Indian Health Service, an Indian tribe or tribal organization and entities receiving funds under title X of the Public Health Service (PHS) Act.

Payments shall be made for:

1) Direct expenses associated with sponsoring an approved graduate medical or dental education training program and

2) Indirect expenses associated with the additional costs relating to teaching residents in such programs.

Eligible community-based ambulatory patient care centers that operate a primary care residency program (family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, and geriatrics) must be listed as the institutional sponsor by the relevant residency accrediting body. A THC that is an essential partner in a GME-sponsoring consortium is also eligible for this funding opportunity. The THC must be listed as the sponsoring institution for the residency program by the relevant accrediting body.

Fiscal Year 2011 THCGME awardees who are proposing to increase the number of new resident slots in FY2012 beyond those already approved during FY 2011 must apply for the expansion through this funding announcement.

The anticipated notice of award date is November 2011; however, the budget period start date for the initial budget period will be July 1, 2012 and ends September 30, 2012 (the close of the Federal Fiscal Year). Funds for the remaining budget period of October 1, 2012 through September 30, 2013 will be available through a post-award renewal that will provide payments for expenses incurred through September 30, 2013. The breakdown of the 15-month period of support reflects the statutory requirement to reconcile payments for costs incurred during the Federal Fiscal Year, as opposed to the academic year.

Technical Assistance:

A general THCGME technical assistance webinar was held on July 18, 2011. A recording of the webinar may be accessed at https://hrsa.connectsolutions.com/p46405923/.

A technical assistance call has been scheduled to help applicants understand, prepare and submit a grant application. Applicants will have an opportunity to ask questions as well. The conference call will be held as follows:

Date: September 16, 2011

Time: 11:00am-12:00pm EST

Toll-free number: 888-324-9619

Passcode: 7209967

The call will be recorded and will remain available until after the closing date of this announcement. Replay information is as follows:

Phone: 203-369-0299

Passcode: 457865

In addition, frequently asked questions and answers will be posted at http://www.hrsa.gov/grants/apply/assistance/teachinghealthcenters.

HRSA-12-029 iii

TABLE OF CONTENTS

I. FUNDING OPPORTUNITY DESCRIPTION 1

1. Purpose 1

2. background 1

II. AWARD INFORMATION 2

1. Type of Award 2

2. Summary of Funding 2

iii. eligibility information 3

1. Eligible applicants 4

2. cost sharing/matching 5

3. other 5

IV. Application and Submission Information 5

1. Address to Request Application Package 5

2. Content and Form of Application Submission 6

i. Application Face Page 9

ii. Table of Contents 9

iii. Application Checklist 9

iv. Staffing Plan and Personnel Information 9

v. Assurances 10

vi. Certifications 10

vii. Project Abstract 10

viii. Project Narrative 10

ix. Attachments 13

3. Submission Dates and Time 15

4. Intergovernmental Review 16

5. Funding Restrictions 16

6. Other Submission Requirements 16

V. application Review information 17

1. Review and Eligibility Screening Process 17

2. anticipated announcement and award dates 17

VI. Award Administration Information 18

1. Award Notices 18

2. Administrative and National Policy Requirements 18

3. Reporting 20

VII. Agency Contacts 21

VIII. Other Information 22

ix. Tips for Writing a Strong Application 22

HRSA-12-029 iii

I. Funding Opportunity Description

1. Purpose

This announcement solicits FY 2012 applications for the Teaching Health Center Graduate Medical Education (THCGME) program. This is a $230 million, five-year initiative which began in 2011 to support an increased number of primary care residents and dentists trained in community-based ambulatory patient care settings. These community-based settings include, but are not limited to, federally-qualified health centers (FQHCs), community mental health centers, rural health clinics and health centers operated by the Indian Health Service or an Indian tribe or tribal organization, and entities receiving funds under title X of the Public Health Service (PHS) Act.

Payments shall be made for:

1) Direct expenses associated with sponsoring an approved graduate medical or dental residency training program; and

2) Indirect expenses associated with the additional costs relating to teaching residents in such programs.

Funding opportunity announcements for this program will be published on an annual basis. New applicants as well as existing THC awardees who want to expand beyond their current funded slots will be eligible to apply, subject to the availability of funds.

2. Background

The Affordable Care Act establishes the Teaching Health Center (THC) program to support medical and dental residency training programs in community-based settings. The THC program exists under the authority of Title III of the Public Health Service Act (PHS), as added by Section 5508 of the Patient Protection and Affordable Care Act of 2010 (P. L. 111-148), which support projects that improve the nation’s access to well-trained primary care physicians and dentists by supporting community-based residency training.

The June 2010 Medicare Payment Advisory Commission (MedPAC) report called for increasing the amount of Graduate Medical Education (GME) time spent in nonhospital settings, changes to GME funding to meet goals such as community-based care, and increasing the diversity of the pipeline of health professionals (MedPAC 2010).

The THC program can help to address the primary care workforce shortage and increase residency training in community-based settings. The THC model has a long history with several successful THCs dating back to the 1980s (Engebretsen 1989, Zweifler 1993). However, the growth of THCs has been limited due to difficulty bringing together the dual mission of training and service in HCs, administrative complexity, and a lack of financial resources (Morris 2009). Recent studies have demonstrated the increased likelihood of THC graduates to practice in HCs and other underserved settings, the challenges and benefits of bringing HCs and residency programs together, and the characteristics of existing THCs (Morris 2008, Rieselbach 2010).

Successful THCs have common elements, foremost of which is an institutional commitment to a dual mission of medical or dental education and service to an underserved patient population, including underrepresented minority and other high risk populations. In addition, there is significant patient- and community-based input into THC operation and management; and THCs have also demonstrated progress toward innovative models of patient care delivery such as the patient-centered medical home, implementation of electronic health records, population-based care management, and use of interdisciplinary team-based care (Morris 2009).

References

Engebretsen BJ. Family medicine and community health centers: A natural alliance. Family Medicine 1989; 21:417-8.

Report to the Congress: Aligning Incentives in Medicare (June 2010). Medicare Payment Advisory Commission. (available at http://www.medpac.gov).

Morris CG and Chen FM. Training Residents in Community Health Centers: Facilitators and Barriers. Annals of Family Medicine 2009; 7:488-94. (available at http://www.annfammed.org/).

Morris CG, Johnson B, Kim S, and Chen FM. Training Family Physicians in Community Health Centers: A Health Workforce Solution. Family Medicine. 2008; 40(4):271-6 (available at http://www.stfm.org/fmhub/).

Rieselbach RE, Crouse BJ, Frohna JG. Health centers: Addressing the workforce crisis for the underserved. Annals of Internal Medicine 2010; 152:118-22.

Zweifler J. Balancing service and education: Linking community health centers and family practice residency programs. Family Medicine 1993; 25:306-11.

II. Award Information

1. Type of Award

Funding will be provided in the form of a formula grant.

2. Summary of Funding

This THCGME Program opportunity will provide payments for expenses incurred in Federal Fiscal Year 2012. The start date for the initial budget period will be July 1, 2012 (to correlate with the academic year start date) and the end date will be September 30, 2012 (the close of the Federal Fiscal Year). Funds for the remaining budget period of October 1, 2012 through September 30, 2013 will be available through a post-award renewal that will provide payments for expenses incurred through September 30, 2013. The breakdown of the 15-month period of support reflects the statutory requirement to reconcile payments for costs incurred during the Federal fiscal year, as opposed to the academic year.

The number of THCs funded will depend upon the number that are deemed eligible, and payment per full-time equivalent will be a function of the number of FTEs being supported per year, along with the formula applied for both DME and IME. Total THCGME payments cannot exceed the amount apportioned. The anticipated notice of award date is November 2011.

Note: Fiscal Year 2011 THCGME awardees who are proposing to increase the number of new resident slots beyond those already approved in their current grant must apply for the increase through this funding announcement.

Funding maybe used only for the costs of new residents in a newly-established THC or an expanded number of residents in a pre-existing THC. For 2012 applicants the baseline number of residents is the number enrolled in academic year 2011-2012. As directed by the THCGME statute, the Secretary will determine GME payments based on Direct Medical Education (DME), by applying a formula that includes using the National Per Resident Amount, among other parameters. The Indirect Medical Education (IME) payment covers additional residency training costs not considered by the DME formula. All GME payments are subject to the availability of funds. The total amount of available funding will be divided among all awardees, distributed as a function of qualified FTE’s per THC. As a result, it is possible that funding for THCGME may fluctuate over time, depending upon the number of eligible applicants. In FY2011, the THCGME interim payment was $150,000 per resident FTE per year, including direct and indirect costs, subject to later reconciliation. With the application of the formula in FY 2012, the payment per resident will change.

The Affordable Care Act also describes the relationship between THCGME funding and other payments that support THC residents, including but not limited to Medicare, Medicaid and Children’s Hospital GME. THCGME payments can supplement, but not duplicate, GME payments from other sources. If a hospital claims the THC residents’ inpatient time, the THC cannot also claim that time from HRSA. HRSA requires applicants to coordinate closely with affiliated teaching hospitals in order to avoid over-reporting of THCGME FTE. Over-reporting of FTE and subsequent over-payment will be subject to the THC reconciliation process and will result in the recoupment of THCGME payments. In addition, HRSA will work closely with CMS to maintain counts of resident FTE in teaching hospitals affiliated with THCs.

Reconciliation: The THCGME statute provides for a reconciliation process, through which overpayments may be recouped and underpayments may be adjusted. (See section 340H (f) of the Public Health Service Act.) The reconciliation process is based on the number of residents reported by the THC for the Federal Fiscal Year to determine the final amount payable to the THC for the Federal Fiscal Year. Reconciliation will occur at the end of each Fiscal Year.

III. Eligibility Information

1. Eligible Applicants

Eligible entities include community-based ambulatory patient care centers that operate a primary care medical or dental (general or pediatric) residency program. Specific examples of eligible entities include, but are not limited to:

· Federally qualified health centers, as defined in section 1905(l)(2)(B) of the Social Security Act;

· Community mental health centers, as defined in section 1861(ff)(3)(B) of the Social Security Act;

· Rural health clinics, as defined in section 1861(aa) (2)of the Social Security Act;

· Health centers operated by the Indian Health service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); and

· An entity receiving funds under title X of the Public Health Service Act.

The THCGME program will support high-quality primary care residency training in high-need, underserved communities. The list of entities above is not exclusive, but does reflect the intent of the program to provide training in settings such as those served by the institutions listed.

Only specific residency training programs are eligible. According to the statute, “Primary care residency program” refers to an accredited graduate medical residency training program in:

· Family medicine;

· Internal medicine;

· Pediatrics;

· Internal medicine-pediatrics;

· Obstetrics and gynecology;

· Psychiatry;

· General dentistry;

· Pediatric dentistry; and

· Geriatrics.

In addition, the eligible entity must be listed as the institutional sponsor by the relevant accrediting body, including the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), or the Commission on Dental Accreditation (CODA). Corporate entities such as a GME consortium collaborating with a health center and hospital in operating one or more primary care GME programs may also be eligible THCs. The corporate entity may be listed as the institutional sponsor, but must ensure that the community-based ambulatory training site is an essential partner in the consortium. THCGME payments must directly support the THC ambulatory training site. The goals of the consortium must include high quality training in teaching health centers and demonstration of new models for community-based GME. The applicant MUST provide documentation that they are accredited, and must name their accrediting body and date of accreditation for verification purposes (see Attachment 2). Residency programs must be accredited at time of application.