FAQs - Primary Care Training and Enhancement: Integrating Behavioral Health and Primary Care Program

Funding Opportunity Number: HRSA-19-086
The following are the most frequently asked questions regarding the Fiscal Year (FY) 2019 Primary Care Training and Enhancement: Integrating Behavioral Health and Primary Care (PTCE: IBHPC) Program’s Notice of Funding Opportunity (NOFO).

Eligibility

  1. Question: Can a Federally Qualified Health Centers (FQHC) which is a sponsor of an ACGME residency program be an applicant?
    Response: A federally qualified health center can collaborate with a lead applicant training program. The lead applicant training program must be a medical school, an academically affiliated physician assistant program or a residency program in family medicine, internal medicine or pediatrics.
  2. Question: There seems to be a contradiction between the definition of an eligible agency and lead applicant.
    Response: The eligible entity (organization) must be an accredited school of allopathic or osteopathic medicine, academically affiliated physician assistant training program, accredited public or nonprofit private hospital, or a public or nonprofit private entity that the Secretary has determined is capable of carrying out such grants. Faith-based and community-based organizations, tribes and tribal organizations may apply for these funds, if otherwise eligible.
    These are training grants. As specified on page 5 of the notice of funding opportunity (NOFO); the lead applicant training program must be from one of the following professions or disciplines: family medicine, general internal medicine, general pediatrics, medical students, physician assistant students, or faculty in any of these areas.
  3. Question: Are tribal outpatient clinics eligible? How do we find out if we are/could be considered a “nonprofit entity that the Secretary has determined is capable of carrying out such grants”?
    Response: Yes, tribal outpatient clinics are eligible to apply if they have an accredited training program that trains medical students, physician assistant students or residents in family medicine, internal medicine or pediatrics, and have the capability and resources to carry out the grant program objectives.
  4. Question: How will it be determined that an accredited public or nonprofit private entity meets the Secretary's assessment of capability of carrying out such a grant? Is it through review of the opportunity submission only, or is there a pre-submission vetting process?
    Response: There is no pre-submission vetting process. An organization (public private non-profit entity) must have an accredited training program that trains medical students, physician assistant students or residents in family medicine, internal medicine or pediatrics, and capability and resources to carry out the grant program objectives.

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Training Program

  1. Question: Do nurse practitioner students or residents qualify under the terms of this award?
    Response: The residency program must be for physicians in family medicine, general internal medicine or general pediatrics. Nurse Practitioner programs can collaborate with eligible entities, in an interprofessional collaborative.
  2. Question: Can this application propose training for other health professionals besides residents?
    Response: As a single project, you need to make sure you address the training levels of students, residents, faculty development and practicing primary care physicians or physician assistants. You must have at least one primary care profession, either physician or physician assistant. It must be in either family medicine, general internal medicine or general pediatrics. It can be a medical student, physician assistant student or faculty. You can have other professionals who are involved, but the primary focus must be students, residents, faculty development and practicing primary care physicians or physician assistants in the professions of family medicine, general internal medicine or general pediatrics.
  3. Question: If a PCA (primary care association) contracts with a medical school to provide training, will the application be accepted or does the medical school have to apply as the lead agency in collaboration with the PCA?
    Response: The medical school has to apply as the lead applicant training program and the PCA could collaborate.
  4. Question: Will an entity that trains both physician assistants and medical students qualify?
    Response: Yes, an entity that educations both physician assistants and medical students would qualify. Please ensure that you following the requirements of either a single or collaborative project (definition can be found in the NOFO).
  5. Question: Would funding a fellowship slot be a level of training?
    Response: No, the training levels are student, resident, faculty, and practicing primary care physician or physician assistant.

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Project Director

  1. Question: If a medical school is submitting must the project director be a physician?
    Response: The project director must be from the profession and discipline of the lead applicant training program (family medicine, internal medicine or pediatrics). (NOFO, page 5)
  2. Question: Does the project investigator need to be a physician or can it be a family medicine faculty member who is not a physician?
    Response: If the faculty member works in the lead applicant training program, she/he could be the project director.

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Collaborative Projects

  1. Question: If the lead applicant is a family medicine physician faculty member, and we collaborate with a department of psychiatry from our same university is that considered collaborative?
    Response: For a collaborative, project must include activities targeting at least two training levels (student, resident, faculty development, and practicing primary care physician or physician assistant) and at least two primary care professions. The lead applicant must be from one of the following professions and disciplines: family medicine, general internal medicine, general pediatrics, medical students, physician assistant students, or faculty in any of these areas. All collaborative interprofessional projects must include at least two of the following professions: primary care physicians, physician assistants, nurse practitioners, dentists, mental health providers, pharmacists, or other allied health professionals.
  2. Question: I thought I heard dentists under the collaborative projects.
    Response: Yes, the following professions are interprofessional collaborative partners: primary care physicians, physician assistants, nurse practitioners, dentists, mental health providers, pharmacists, and other allied health professionals.
  3. Question: Can a collaborative partner be a clinical psychology department?
    Response: Yes, as long as they have an accredited training program. Please see the response to question 13
  4. Question: Would a different profession within the same family medicine department be considered collaborative (ex: Family Medicine MD faculty and Family Medicine PhD psychologist)?
    Response:   No, this isn’t a collaboration. Please see the response for question 13.
  5. Question: Is collaboration with a physician assistant program required?
    Response: No, as long as you meet the criteria for a collaborative project, which is that collaborative project must include activities targeting at least two training levels (student, resident, faculty, and practicing primary care physician or physician assistant) and at least two primary care professions.
  6. Question: Can you collaborate with professions that are not deemed eligible if you have a third collaborator that is?
    Response: No, collaboration is with professions that are deemed eligible. Please see response to question 13.
  7. Question: Can family medicine residency programs apply to work with a physician assistant program?
    Response: That appears to meet the definition of collaborative project – as long as it is targeting at least two training levels (student, resident, faculty and practicing primary care physician or physician assistant) and at least two primary care professions.
  8. Question: Would social work count as a mental health counseling discipline?
    Response: It would depend on if they are being educated to become a mental health provider.
  9. Question: Would psychiatrists fall under mental health providers in the collaborative interprofessional project?
    Response: If a psychiatrist is a mental health provider, then yes it would meet the requirements of one of the interprofessional collaborative disciplines.
  10. Question: Do all collaborative partners need to be accredited training programs?
    Response: Page six of the NOFO indicates, under Collaborative Project Documentation, that in addition to your accreditation documentation, you must include a statement on the accreditation status for all other training programs involved in your collaborative project.

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Single Projects

  1. Question: Can a Federally Qualified Health Center (FQHC) apply as a single applicant to increase training opportunities for current providers and increase full time equivalent (FTE) for the behavioral health clinic?
    Response: No, an FQHC cannot apply as a single applicant to increase training opportunities for current providers and increase FTE for the behavioral health clinic. However, an FQHC can apply as a single applicant if they have an accredited training program for medical students, physician assistant student or residency programs in family medicine, internal medicine or pediatrics.

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Review Process and Funding Preference

  1. Question: Do you take all programs that have a preference with a medically underserved area first before considering programs that do not meet the eligibility requirement (funding preference requirement)?
    Response: No, you do not have to request a funding preference. All eligible applications will be reviewed based on the review criteria noted in the Notice of Funding Opportunity.
  2. Question: So, how does a funding preference help you in the review process?
    Response: Applicants receiving the preference will be placed in a more competitive position among applications that can be funded. Applications that do not request a funding preference will receive full and equitable consideration during the review process. In order to receive the funding preference, applicants must clearly indicate the funding preference for which they are applying in the Project Abstract and provide supporting documentation. The qualification is evaluated based on the data provided by the lead applicant’s training program.
  3. Question: Will priority be given to organizations with larger numbers of trainees?
    Response: There is no priority given for larger numbers of trainees. The applications are reviewed and scored based on the review criteria outlined in the notice of funding opportunity (for the review criteria see pages 21-24).
  4. Question: How many points are awarded for special consideration?
    Response: There are no points associated with special consideration. As indicated on page 28 of the NOFO, special consideration may be given to assure geographic distribution across all awards, and to assure that HRSA meets the legislative requirement for PCTE physician assistant funding.
  5. Question: Are you able to please provide an estimate of the probability of funding should an application not qualify for a preference?
    Response: We are unable to provide an estimate.
  6. Question: Does the development of a psychology internship program within an existing residency, count as a new program?
    Response: The purpose of this program is not to be able to develop a psychology internship. A new program, for the purpose of this NOFO, means those medical schools, physician assistant schools or residency training programs that have completed training in less than three consecutive classes.
  7. Question: Can you tell us how to verify whether a community is rural or underserved?
    Response: If you are referring to a medically underserved community (MUC), please refer to page 25 - an MUC is defined as a geographic location or population of individuals that is designated by the federal government as a Health Professional Shortage Area (HPSA) or Medically Underserved Area and Population (MUA/P). More information on HRSA shortage designations, including a link to find HPSAs and MUAs/Ps by address, is available on the Shortage Designation page.
  8. Question: When looking at the high rate preference, how can a medical school qualify for this if graduates from AY 2016-2017 and AY 2017-2018 who are in residency programs are not considered to be “in practice” and therefore not in the numerator? Wouldn’t all medical school graduates proceed to residency?
    Response: Per the NOFO on pages 25-26 regarding how High Rate with medical school graduates is calculated:
    • To calculate the MUC Preference by demonstrating High Rate with medical school graduates, the numerator will be the number of graduates from AY 2013-2014 who are currently practicing in a MUC added to the number of graduates in AY 2014-2015 who are currently practicing in a MUC.
    • Medical school graduates who are currently in residency or fellowship training are not considered in practice and should not be included in the numerator.
    • The denominator will be the total number of medical school graduates in AY 2013-2014 added to the total number of medical school graduates in AY 2014-2015.
  9. Question: Can you please further define what is meant by tracks such as primary care, rural tracks or regional campus within an existing organization?
    Response: New programs for the purpose of this NOFO means those medical schools, physician assistant schools or residency training programs that have completed training of less than three consecutive classes. If you are starting a new medical school, a new physician assistant school or a new residency program that would be considered. You have to have less than three consecutive classes to be considered a new program. If you already have a medical school and you are developing a primary care track that would not be considered a new program.

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Budget/Funding

  1. Question: Are post-doctoral fellows training, research and stipends allowed for this award?
    Response: Stipends are only allowed for physician assistant students.
  2. Question: Can funds be used to support a fellowship slot, and would that be considered another level of training?
    Response: No, funds cannot be used to support a fellowship slot; that is not considered a level of training in this NOFO.
  3. Question: Please provide further clarification regarding hiring that can be done for this grant. It appears that it can be used to fund an existing position (e.g. increase FTEs for existing Behavioral Health Consultant) but it would not be possible to budget for a salaried fellow. Please clarify how the funding can be allocated to support additional hires to support project goal (training):
    Response: Funding requests must support the proposed project personnel based on their role, time and effort on the grant.

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Program Purpose

  1. Question: Is this program limited to providing care to people with opioid addiction or does it include providing care?
    Response: As indicated in the program purpose on page 1, the purpose of the program is to fund innovative training programs that integrate behavioral health care into primary care, particularly in rural and underserved settings with a special emphasis on the treatment of opioid use disorder. The objectives of this program are to:
    1. Enhance primary care training in integrated behavioral health and primary care and advance primary care clinical training sites using the Framework for Levels of Integrated Healthcare;
    2. Initiate new or enhance existing training in opioid and other substance use disorders, including clinical experiences in opioid and other substance use disorders, Medication Assisted Treatment (MAT), and enhancements to the clinical training sites and faculty development as needed; and
    3. Develop and implement a systematic approach to improve trainee and provider wellness.
  2. Question: If we currently are funded in a PCTE grant, may we also submit for this program using a different scope of work?
    Response: If you are already receiving funding from a PCTE award, you are not prohibited from submitting an application for this program. However, you may not duplicate any of the efforts currently funded in another award.
  3. Question: If our healthcare system is at a level 3 and/or 4 of the integrated care levels, would we be as competitive as other proposals who are more at the levels 1 or 2?
    Response: The applications that are submitted for this NOFO are reviewed/evaluated based on the specified review criteria.
  4. Question: Does this program specifically allow a first year “planning period” which would occur prior to actually engaging trainees?
    Response: No, a planning year is not allowed for this program.

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Other:

  1. Question: For institutions with multiple sites located in different states, can a single site apply under this mechanism?
    Response: Multiple applications from an organization are allowable, however, only one award will be made per organization. Separate organizations are those entities that have unique DUNS numbers. Refer to page 6 of the NOFO under section 3, Other Eligibility for more information.
  2. Question: Does it have to be an integrated clinic with primary care or behavioral health providers present or can it be separate?
    Response: The NOFO doesn’t specify, however, one of the objectives is to enhance primary care training in integrated behavioral health and primary care and advance primary care clinical training sites using the Framework for Levels of Integrated Healthcare. Please note that applicants submitting proposals can be at different levels of the integration continuum.

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Date Last Reviewed:  January 2019