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  6. Rural Residency Planning and Development (RRPD) Program Frequently Asked Questions

Rural Residency Planning and Development (RRPD) Program Frequently Asked Questions

Updated December 6, 2023

1. Can I apply to expand the number of residents, training sites, etcetera, in an existing residency program?

This funding supports the development of new, sustainable rural residency programs or rural track programs (RTPs), including existing programs that permanently increase its resident complement through ACGME’s RTP designation process by adding a new rural site (i.e., new RTP) training residents in rural areas for greater than 50 percent of the total residency training.

2. What is the definition of “rural”?

Entities that meet the Federal Office of Rural Health Policy (FORHP) definition of rural are eligible to apply for the program (refer to the Rural Health Grants Eligibility Analyzer). However, if the applicant’s sustainability plan includes certain Center for Medicare and Medicaid Services (CMS) Medicare Graduate Medical Education (GME) funding, entities must also meet CMS definition of rural. CMS defines rural in accordance with Medicare regulations at 42 CFR 412.62(f)(iii); that is, a rural area is any area outside of an urban area. This excludes hospitals that are physically located in an urban area, but reclassify to a rural area under 42 CFR 412.103 which are treated as rural for indirect medical education payment purposes, but not for direct GME. To determine if a hospital is located in a county that is rural for Medicare payment purposes, refer to the FY 2024 “County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File” that is available on the FY24 IPPS Final Rule Homepage. Please note that either the applicant or a consortium’s primary training partner must be in a rural area.

For this funding opportunity, applicants proposing a sustainability plan using Medicare GME must also demonstrate that their clinical training site(s) currently meeting both CMS and FORHP definitions of rural will meet CMS rural requirements in future years by documenting that the county is not in a metropolitan area delineated in OMB Bulletin No. 23-01 (PDF - 1 MB), release July 21, 2023. See Appendix C of the NOFO for more information.

3. Can an organization or hospital located in an urban area apply?

An applicant organization (e.g., urban hospital, allopathic or osteopathic medical schools) located in an urban area may apply under a Graduate Medical Education consortium model where at least one consortium member must be a rural primary clinical training partner. Entities must ensure that their primary training partner(s), where greater than 50 percent of the training will occur, is located in a rural area.

4. Can funding support development of a residency program in other specialties or subspecialties, for example, Child and Adolescent Psychiatry?

No. This grant is not intended to support specialties and subspecialties not listed in the NOFO. The purpose of this grant program is to develop new rural residency programs or RTPs in the following six medical specialties:

•    Family medicine
•    Internal medicine
•    Psychiatry
•    Preventive medicine 
•    General surgery
•    Obstetrics and Gynecology

5. Can funding support development of residency programs for other primary care health professional disciplines (e.g., nurse practitioners, physician assistants), or for fellowships?

No. This grant supports the development of new rural residency programs or RTPs for physicians that are accredited by the Accreditation Council on Graduate Medical Education (ACGME).

6. Can I apply if my program has just received initial accreditation or a permanent complement increase for a new RTP?

Programs that will achieve ACGME program accreditation or have applied for ACGME Rural Track Program designation and received a permanent complement increase by February 12, 2024 (the application due date) are not eligible for RRPD funding. 

7. Am I eligible to apply to this program if I have a current RRPD award?

Award recipients under the previous RRPD Program funding notices (HRSA-19-088, HRSA-20-107, HRSA-22-094, and HRSA-23-037) and the Teaching Health Center Planning and Development (THCPD) Program (HRSA-22-107 and HRSA-23-015) are eligible to apply under this RRPD funding opportunity, if proposing a new rural residency program, including RTPs, in a different specialty from the previously funded award. The recipient of RRPD-TA Program (HRSA-21-102) award is not eligible under this RRPD funding opportunity.

8. Can I use grant funding to support resident salaries and benefits, such as stipends, sign-on bonuses, housing, etc.?

No. Award recipients may not use grant funds to cover any resident salaries and benefits. To find more on funding restrictions, refer to page 33 in the HRSA-24-022 funding opportunity and the HRSA SF-424 Application Guide (PDF - 663 KB).

9. Do I have to start training residents during the grant period of performance?

No. Award recipients must establish a new rural residency program or RTP by the end of the grant and matriculate their first resident class no later than the academic year (AY) immediately following the end of the grant.

10. Which preventive medicine specialty residency programs are eligible?

Occupational and Environmental Medicine and Public Health & General Preventive Medicine residency programs are eligible for this program.

11. Are programs that have obtained accreditation for the sponsoring institution but have not yet received program accreditation for the residency program eligible to apply for RRPD funding?

Yes. Residency programs with an accredited sponsoring institution but without residency program accreditation by the RRPD application due date are eligible to apply for RRPD funding.

12. What does it mean for family medicine programs to prepare residents for the independent practice of obstetrics?

For the family medicine with enhanced obstetrical training specialty, enhanced obstetrical residency training must provide family medicine residents with extensive clinical experience in comprehensive maternity care, as outlined in ACGME’s program requirements, including dedicated training on labor and delivery. These programs must have faculty with clinical expertise to prepare family medicine residents for the independent practice of obstetrics in rural communities. Meeting ACGME Family Medicine Program Requirements to incorporate comprehensive pregnancy-related care is sufficient to meet the requirements of this NOFO. Effective July 1, 2023, ACGME revised Family Medicine Program requirements contain updates for maternity care, including robust requirements on comprehensive pregnancy-related care. Per ACGME, “Residents who seek the option to incorporate comprehensive pregnancy-related care, including intrapartum pregnancy-related care and vaginal deliveries into independent practice, must complete at least 400 hours (or four months) dedicated to training on labor and delivery and perform or directly supervise at least 80 deliveries”. Refer to ACGME’s family medicine Program Requirements for more information.

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