Full Text HS-94-005 NATIONAL RESEARCH SERVICE AWARD--INSTITUTIONAL GRANTS NIH GUIDE, Volume 22, Number 43, November 26, 1993 RFA: HS-94-005 P.T. 44 Keywords: Health Services Delivery 0730021 Agency for Health Care Policy and Research Application Receipt Date: February 10, 1994 PURPOSE The Agency for Health Care Policy and Research (AHCPR) awards National Research Service Award (NRSA) institutional grants to eligible institutions to develop or enhance research training opportunities for qualified individuals selected by the institution who have demonstrated an interest in health services research and who seek to prepare for careers in the systematic examination of the organization, provision, and financing of health care services. The purpose of these awards is to assist domestic institutions in supporting predoctoral and postdoctoral academic training. The awards allow trainees to gain one or more years of experience in applying research methods to the evaluation of health services. The AHCPR does not support short-term training. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. The AHCPR urges applicants to submit grant applications with relevance to the specific objectives of this initiative. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-004374-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY Applicant Institutions Domestic non-profit private and public institutions may apply for grants to support doctoral and postdoctoral health services research training programs. The applicant institution must have the staff and facilities required for the proposed program. The training program director at the institution will be responsible for the selection and appointment of trainees and for the overall direction of the program. Institutions may apply for support for predoctoral students, postdoctoral students, or a combination. Applicants should include a rationale for their proposed choice of supporting the level(s) of students requested. An applicant may request as many postdoctoral or predoctoral positions as the proposed program can adequately accommodate; but the number of positions awarded will be determined by the review process, program needs, and availability of funds. Trainees Trainees appointed to the proposed training program must have the opportunity to carry out supervised health services research with the primary objective of extending their research skills and knowledge in preparation for a health services research career. Prospective trainees must be U.S. citizens or noncitizen nationals or permanent residents of the United States in possession of an Alien Registration Receipt Card I-551 or I-151, or other legal verification of such status at the time of appointment. Individuals on temporary or student visas are not eligible. A postdoctoral student, as of the beginning date of the NRSA appointment, must have a Ph.D., M.D., Dr.P.H., Sc.D, D.N.Sc. or other doctoral degree, or an equivalent degree from any accredited domestic or foreign institution. (For purposes of NRSA appointments, persons holding the J.D. are not considered postdoctoral trainees unless they also hold the L.L.M. degree.) Certification by an authorized official of the degree-granting institution that all requirements for the doctoral degree have been met is acceptable. Predoctoral trainees must have received a baccalaureate degree as of the beginning date of the NRSA appointment and must be enrolled in a program leading to a Ph.D., Dr.P.H., or equivalent doctoral degree. Individuals working toward a medical or dental degree who wish to interrupt their studies to engage in full-time research training for a year or more before completing their health professional degree are eligible for NRSA support with approval from AHCPR. MECHANISM OF SUPPORT The mechanism of support will be the National Research Service Award (NRSA) institutional training grant (T32). FUNDS AVAILABLE The AHCPR expects to fund approximately three awards in response to this RFA; the total funds available are not expected to exceed $500,000. This is a one-time solicitation and is made subject to availability of funds. The AHCPR reserves the right to withdraw this Request for Applications (RFA) if funds do not become available. RESEARCH OBJECTIVES Areas of Training AHCPR-sponsored NRSA Awards emphasize multidisciplinary health services research training. This training should provide a rigorous conceptual and methodological foundation for investigating some or all of the following health care areas: o Determinants of successful health care market reform, including incentives for selection of efficient plans by health care purchasers and effective management by health care providers; o Cost-effectiveness and cost-benefit analysis, including allocation of health care resources and its relationship to health status; o Analysis of service delivery, resource use, and costs of care for persons with HIV-related illnesses; o Primary care issues, including relationships between the structure and organization of service delivery, and access to and costs and outcomes of care; o Evaluation of managed care and other alternative approaches to organizing, financing, and reimbursing health care services; o Alternative delivery systems, providers, and practice patterns in long-term care including home and community- based care; o Medical treatment effectiveness issues, including evaluation of outcomes associated with the use of clinical practice guidelines; o Availability, accessibility, effectiveness, and quality of care for underserved populations such as low-income groups and minorities; o Rural health issues, including primary care access, service delivery, technology diffusion, and supply of health professionals; o Medical malpractice and liability; o Appropriateness and effectiveness, including cost effectiveness, of alternative treatments and technologies; o Factors affecting dissemination and assimilation of health and clinical information to practitioners and patients; o The development of measures, methods, and technologies to support quality assurance and foster quality improvement in health care; and o Application of medical informatics to developing and improving expert systems for clinical diagnosis and treatment selection. Levels and Types of Training Permitted NRSA Awards may not be used to support studies leading to the M.D. or other similar professional degrees, or to support residencies, that is, postgraduate training for health professionals providing health care directly to patients where the majority of their time is spent in nonresearch clinical training. However, if a specified period of full-time research training is creditable toward specialty board certification, the NRSA may support such research training if the trainee has shown a strong interest in a research career. Trainees are required to pursue their research training on a full-time basis. Because of the close relationship between teaching and research in the academic environment, trainees are permitted, with the approval of AHCPR, to teach if it can significantly contribute to their academic training. Teaching by trainees may not take up more than 10 percent of work time during the year or exceed four hours each week. Research trainees who are clinicians are expected to devote full time to the proposed research training. Clinical duties are permitted for up to 10 percent time (four hours per week) within the training program only if they relate to the training itself. Trainees appointed to the program are expected to carry out supervised health services research with the primary objective of extending their quantitative research skills and substantive knowledge in preparation for a career in health services research. Duration of Support Institutional grants are made for competitive segments of five years and are renewable; individual trainee appointments should be made in increments of 12 months. No individual trainee may receive more than five years of aggregate NRSA support at the predoctoral level and three years of aggregate NRSA support at the postdoctoral level, including any combination of support from institutional training grants and individual fellowship awards, except under certain circumstances. Any exception to this policy requires a waiver from the AHCPR. Recruitment and Retention of Trainees The primary objective of the NRSA program is to prepare qualified individuals for careers in health services research. Within the framework of the program's commitment to excellence and projected needs for investigators in particular areas of health services research, attention must be given to recruiting individuals from minority groups that are underrepresented nationally in health services research. Application information on plans for the recruitment of trainees must include a description of steps to be taken for the recruitment of individuals from underrepresented minority groups. Applications without a description of a minority recruitment plan will be considered incomplete and will not be reviewed until this information is provided. Institutional training grants are a desirable mechanism for postdoctoral training of physicians and other health professionals whose doctoral training has usually involved limited health services research experience. For such individuals, it is highly recommended that they agree to engage in at least two years of research training or comparable experiences at the time of appointment regardless of whether or not the NRSA training is part of a research degree program. Payback Provisions All postdoctoral trainees must sign an agreement to fulfill the NRSA payback requirements when they are initially appointed to a training grant (or receive an individual fellowship). The NIH Revitalization Act of 1993 substantially modifies the existing service payback requirements for individuals supported under NRSA programs. Beginning with new appointments (or reappointments) made as of June 10, 1993, the following new guidelines apply: Predoctoral trainees will not be required to sign the Payback Agreement Form (PHS Form 6031) and will not incur a service payback obligation. Postdoctoral trainees in the first 12 months of postdoctoral NRSA support will incur one month of obligation for each month of support. Postdoctoral trainees in the 13th and subsequent months of NRSA support will not sign the Payback Agreement Form and will incur no further obligation. The 13th and each subsequent month of postdoctoral NRSA support will be considered acceptable payback service; therefore, individuals who are appointed to their initial NRSA postdoctoral period on or after June 10, 1993, and continue under that award for two years will have fulfilled their first year obligation by the end of the second year. Service payback obligations can be repaid after the period of training by engaging in health services related research and/or teaching for at least 20 hours per week averaged over a full year. Recipients must undertake the obligated service on a continuous basis within two years after termination of NRSA support. The period for undertaking payback service may be delayed for temporary disability, for completion of residency requirements, or for completion of the requirements for a graduate degree. Requests for an extension must be made in writing to AHCPR and must specify the need for additional time and the length of the required extension. Recipients of NRSA support are responsible for informing AHCPR of changes in their status or address. Individuals who fail to fulfill their obligation through service must pay back the total amount of NRSA funds paid to them for the obligation period plus interest at a rate determined by the Secretary of the Treasury. Financial payback must be completed within three years beginning on the date the United States becomes entitled to recover such amount. Under certain conditions, the Secretary of Health and Human Services may extend the period for starting service or for repayment, permit breaks in the period of service or repayment, or otherwise waive or suspend the payback obligation of an individual. Officials of the applicant organization responsible for recruitment of trainees should familiarize themselves with the terms of the service requirements and explain them carefully to prospective training candidates before an appointment at the institution is offered. Stipends and Other Trainee Support Stipends National Research Service Awards provide funds in the form of stipends to predoctoral and postdoctoral trainees. A stipend is provided as an allowance for trainees to help defray living expenses during the research training experience. It is not provided as a condition of employment with either the Federal Government or the institution. Trainees may not receive stipends for periods during which they are not enrolled in the training program. For predoctoral trainees at all levels of experience, the stipend level (effective October 1, 1990) is $8,800 per year. For postdoctoral trainees, the stipend for the first year of support is determined by the number of full years of relevant postdoctoral experience at the time of appointment. Relevant experience may include research experience (including industrial), teaching, internship, residency, clinical practice, or other time spent in full-time studies in a health-related field beyond that of the qualifying doctoral degree. The stipend for each additional year of NRSA support is the next level on the stipend scale. Current postdoctoral stipend levels, effective October 1, 1990, are as follows: Full years of relevant experience Stipend None $18,600 1 19,700 2 25,600 3 26,900 4 28,200 5 29,500 6 30,800 7 or more 32,300 Supplementation and Compensation NRSA stipends may be supplemented by an institution from non-Federal funds. Federal funds may be used for stipend supplementation only if specifically authorized under the terms of the program from which the supplemental funds are derived. An individual may make use of Federal educational loan funds or VA benefits when permitted by those programs. Supplementation, when provided, must be without obligation to the trainee. Trainees may be permitted to receive compensation for work in some other position (for example, teaching or laboratory assistance) when the trainee is in an employee-employer relationship, the payments are for services rendered, and the situation otherwise meets conditions for student compensation as specified in the PHS Grants Policy Statement. Compensation may not be paid from a research grant that supports the trainee's dissertation or the same research as that of the training program. Compensation for services must occur on a limited, part-time basis apart from the normal full-time training activities that require a minimum of 40 hours per week. Under no circumstances may the conditions of either stipend supplementation or student compensation for coincidental employment detract from or prolong the research training. Further information on stipend supplementation and compensation is available in "National Research Service Awards -- Guidelines for Individual Awards - Institutional Grants," NIH Guide for Grants and Contracts (special edition), Volume 13, Number 1, January 6, 1984. Tax Liability of Stipends Section 117 of the Internal Revenue Code applies to the tax treatment of all scholarships and fellowships. Under that section, degree candidates may exclude from gross income, reported for tax purposes, any amount used for tuition and related expenses such as fees, books, supplies, and equipment required for courses of instruction at the educational institution. Nondegree candidates are required to report as gross income all stipends and monies paid on their behalf for course tuition and required fees. The taxability of stipends in no way alters the relationship between NRSA trainees and their institutions. NRSA stipends are not now, and never have been, salaries. Trainees supported under a National Research Service Award are not in an employer-employee relationship with AHCPR or with the institution in which they are pursuing research training, nor are they considered to be self-employed. Stipends are not subject to employment or self-employment tax (FICA). It must be emphasized that the interpretation and implementation of tax laws are the domain of the Internal Revenue Service (IRS). AHCPR is not in a position to advise students or institutions about their tax liability. Individuals should consult their local IRS office for more detailed information on the proper steps to be taken regarding their tax obligations. Other Training Costs Tuition and fees, including medical insurance for the trainee, are allowable trainee costs if such charges are required of all persons in a similar training status at the institution, regardless of their source of support; family medical insurance is not an appropriate charge to the NRSA grant. Tuition for postdoctoral trainees not enrolled in a degree program is limited to that required for specific courses in support of the approved training program; tuition for other courses must be justified. Annual increments in tuition costs beyond the first year of the award may not exceed six percent for an equivalent number of trainees. Domestic travel by trainees, including attendance at scientific meetings, that the institution determines to be necessary to the individual's training is an allowable cost. Institutional costs of $1,500 per year for each predoctoral trainee and $2,500 per year for each postdoctoral trainee may be requested to defray the cost of other expenses related to the training program. Salaries of the program director and faculty are not reimbursed. The institution will receive indirect costs based on eight percent of total allowable direct costs (exclusive of tuition, fees, and health insurance) or their actual indirect cost rate, whichever is less. Applications from State and local government agencies may request full indirect cost reimbursement. APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 9/91) is to be used. (State and local government agencies may use form PHS 5161 and follow those requirements for copy submission.) This revision includes special instructions for institutional NRSA research training grants. Applicants are reminded that the 25-page limit on the narrative section must be observed. These forms are available at most institutional offices of sponsored research; the Office of Grant Information, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone 301-710-0267; and the Scientific Review Branch, Agency for Health Care Policy and Research, 2101 East Jefferson Street, Suite 602, Rockville, MD 20852, telephone 301--594-1449. Insert the title of this RFA (National Research Service Award--Institutional Grants) and RFA number (HS-94-005) on line 2a of the application face page and the YES box must be marked. The RFA label found in the PHS 398 must be affixed to the bottom of the face page of the original copy of the application. Failure to use this label could result in delayed processing of the application such that it will not reach the review committee in time for review. Applications must be received at the Division of Research Grants, NIH, by February 10, 1994. Late applications will be returned to the applicant. The completed, signed, original application and three legible copies of the form PHS 398 must be sent or delivered to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** Two information copies must be submitted simultaneously to: Director, Office of Scientific Review Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 602 Rockville, MD 20852 Failure to provide these information copies will result in the return of the application to the applicant. REVIEW CONSIDERATIONS Applications will be reviewed by an AHCPR initial review group (IRG) and by the National Advisory Council for Health Care Policy, Research, and Evaluation. The NRSA training grant receipt date is February 10, 1994. Grants will be awarded by September 30, 1994. Review Criteria The initial review group will consider the following criteria in its review: o Qualifications and responsibilities of the program director; o Qualifications of the program's faculty, including ongoing health services research support and ability to serve as effective mentors for trainees; o Objectives and design of the proposed training program and the probability of achieving stated goals; o Substantive content of the proposed program and its relevance to current health care concerns, including descriptions of courses offered; o Documentation of availability of qualified candidates and program's plans for recruitment and selection of trainees; o Institutional commitment to providing a quality training environment, including availability of space and facilities, curriculum time, and research support; o Demonstration of cooperation by any collaborating facilities or institutions in providing experience and research training sites for trainees and mechanisms for integration of trainees; o Proposed methods for monitoring and evaluating performance of trainees and of the overall program, including tracking of graduates after completion of training and record of trainees in obtaining individual research awards or fellowships following training and in establishing careers in health services research; o Record of the training program in retaining health professional postdoctoral trainees for more than one year of research training; and o Reasonableness of the proposed budget, including number and levels of trainees, in relation to the research training. Also see "Modification of Existing Review Criteria for NRSA Institutional Research Training Grants," NIH Guide for Grants and Contracts, Volume 21, Number 11, March 20, 1992. In addition, applicant institutions will be evaluated on the acceptability of their proposed plans for instruction in the responsible conduct of research and for recruiting individuals from underrepresented minority groups into the proposed training program, as delineated below. Prospective applicants should consult the NIH Guide for Grants and Contracts, Volume 21, Number 43, November 27, 1992, and Volume 22, Number 25, July 16, 1993, for detailed information on these two issues. Minority Recruitment Plan The AHCPR remains committed to increasing the participation of individuals from underrepresented minority groups in health services research. All competing applications must include a plan to recruit individuals from underrepresented minority groups, and review of any application received without a plan will be deferred until a plan is provided. During initial review, reviewers will assign a priority score for the overall technical and educational merit of the application. Then, one or more assigned reviewers will discuss the minority recruitment plan and any record of recruitment and retention efforts. The recruitment components of each application will be judged as either acceptable or unacceptable. The findings of the review committee on the plan for attracting minority individuals will be presented in an administrative note in the summary statement. Funding of any application with a plan for recruiting underrepresented minorities that is judged unacceptable by the review committee will be withheld until a revised plan that addresses the deficiencies is received. AHCPR staff will determine whether or not amended plans submitted after initial review are acceptable. Information on the recruitment and retention of underrepresented minority trainees appointed during the previous budget period must also be provided in progress reports included in noncompeting continuation applications. Training in the Responsible Conduct of Research Every predoctoral and postdoctoral trainee supported by a NRSA institutional training grant must receive instruction in the responsible conduct of research. Applications must include a description of formal and any informal instruction that addresses various aspects of scientific integrity and the responsible conduct of research. It is expected that the plan will be appropriate to the training program and will demonstrate commitment of the institution in both personnel and materials. Although the exact content of the plan is left to the individual training program, suggested areas of instruction include conflict of interest, responsible authorship, policies for handling misconduct, policies regarding the use of human subjects, and data management. The plan to provide instruction in the responsible conduct of research will be assessed on the appropriateness and breadth of topics; instructional format and materials; amount, nature, and quality of faculty participation; and frequency and duration of the training. Plans will be rated as acceptable or unacceptable by the initial review group. The plan and acceptability will be described in an administrative note in the summary statement. The plan to provide instruction in the responsible conduct of research will not be considered in the assignment of a priority score to the application. However, applications that do not contain such a plan will be considered incomplete and an award will not be made until an adequate plan is provided. Council Review In addition to IRG recommendations on the scientific and technical merit of the applications and the acceptability of plans for minority recruitment and training in the responsible conduct of research, the National Advisory Council for Health Care Policy, Research, and Evaluation will consider the application within AHCPR's overall research and training goals. AWARD CRITERIA Funding decisions will be made based on the IRG and Council recommendations, the need for research personnel in specified program areas, balance among types of research training supported by AHCPR, and the availability of funds. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: DonnaRae Castillo NRSA Project Officer Agency for Health Care Policy Research 2101 East Jefferson Street, Suite 501 Rockville, MD 20852 Telephone: (301) 594-1362 Direct fiscal and administrative inquiries to: Ralph Sloat Grants Management Branch Agency for Health Care Policy Research 2101 East Jefferson Street, Suite 601 Rockville, MD 20852 Telephone: (301) 594-1447 AUTHORITY AND REGULATIONS NRSA institutional research training grants are made under authority of Section 487 of the Public Health Service (PHS) Act as amended (42 USC 288). Title 42 of the Code of Federal Regulations, Part 66, is applicable to this program. The program is described under Catalog of Federal Domestic Assistance No. 93.225. This program is not subject to the intergovernmental review requirements of Executive Order 12372. .
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