Updated March 20, 2025
1. Where can I review the recorded technical assistance webinar for HRSA-25-007?
Watch the technical assistance webinar
2. Can I apply to expand the number of residents, training sites, etcetera, in an existing residency program?
The purpose of the RRPD Program is to fund the development of new rural residency programs in qualifying medical specialties. For this funding opportunity, we consider "new" programs to include existing programs that apply for a permanent complement increase to train additional residents at new rural training site(s) as part of a rural track program (RTP).
We do not consider the following to be new programs:
- Programs that have received a permanent complement increase for their proposed RTP before the application due date
- Programs seeking to increase resident full-time equivalents at an existing RTP site(s) without adding a new rural training site or sites
Programs expanding to new rural training sites through a permanent complement increase should demonstrate that more than 50% of the training time will occur in new rural training sites.
3. What is the definition of "rural"?
While there are many definitions of rural, two definitions are used for the RRPD program: the HRSA Federal Office of Rural Health (FORHP) and the Centers for Medicare and Medicaid Services (CMS) rural definitions.
The RRPD Program funds the development of new rural residency programs in qualifying medical specialties.
To be reviewed, your application must propose to train residents in clinical training sites that are physically located in a rural area as defined by HRSA's FORHP for greater than 50% of their total time in residency. This aligns with the RRPD definition of a rural residency program. Use the Rural Health Grants Eligibility Analyzer to determine whether FORHP considers a geographical area to be rural.
In addition to the FORHP rural definition, RRPD also uses the CMS rural definition. Some sustainability options require that clinical training sites are physically located in CMS rural areas. CMS defines "rural" in accordance with Medicare regulations at 42 CFR 412.62(f)(1)(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 and thus are treated as rural for indirect medical education (IME) purposes, but not for direct graduate medical education (DGME). Please note that FORHP's definition of rural may differ from CMS, which is an important distinction to understand when developing a financial sustainability plan based on Medicare GME funding.
To learn more about sustainability options for RRPD programs, see pages 13-15 of the HRSA-25-007 funding opportunity. For information about application requirements for program sustainability, including rurality requirements, see pages 31-37 of the funding opportunity. See page 77 of the funding opportunity for more details on rural definitions. For information about including rural status in Attachment 1, see question 13 below.
4. Can an organization or hospital located in an urban area apply?
Yes. All applicants must propose a new rural residency program that train residents in clinical training sites that are physically located in a rural area as defined by HRSA's Federal Office of Rural Health Policy (FORHP) for greater than 50% of their total time in residency. You must attest that the program will meet this requirement.
If your organization is not located in a rural area, you must also demonstrate that you can train residents in rural facilities, by one of the following:
- Operating a clinical site in a rural area as defined by HRSA's FORHP
- Demonstrating that you are part of a consortium where at least one consortium member operates a clinical training site in rural area
5. Can funding support development of a residency program in other specialties or subspecialties, for example, Child and Adolescent Psychiatry?
No. This grant will not support specialties and subspecialties outside of those listed in the HRSA-25-007 funding opportunity.
The purpose of this grant program is to develop new rural residency programs or RTPs in the following qualifying medical specialties:
- Family medicine
- Internal medicine
- Psychiatry
- Preventive medicine
- General surgery
- Obstetrics and gynecology
6. Which preventive medicine specialty residency programs qualify for this funding opportunity?
Occupational and Environmental Medicine and Public Health & General Preventive Medicine are qualifying specialties for this program.
7. 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 physician rural residency programs, including RTPs, that are accredited by the Accreditation Council on Graduate Medical Education (ACGME).
8. Can I apply if my program has just received initial accreditation or a permanent complement increase for a new RTP?
No. We do not consider programs that have received accreditation or a permanent complement increase for their proposed rural residency program before April 10 to be new programs. To be responsive to the program purpose and be considered for funding, you must propose a new rural residency program in a qualifying medical specialty.
9. We have obtained institutional accreditation but have not received program accreditation for the residency program. Are we eligible to apply for RRPD funding?
Yes. You can apply with an accredited sponsoring institution, as long as you have not received program accreditation that is effective on or before April 10, 2025.
10. Am I eligible to apply to this program if I have a current RRPD award?
Yes. However, please note that there is a special consideration to prevent significant overlap of service areas between new proposals and current and former RRPD recipients. To learn more about the special consideration, refer to page 58 of the HRSA-25-007 funding opportunity.
11. 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 pages 17 and 39 of the HRSA-25-007 funding opportunity and page 15 of the Application Guide (PDF - 622 KB).
12. Do I have to start training residents during the grant period of performance?
No. Award recipients must achieve accreditation for their new rural residency program or RTP by the end of the grant period and matriculate their first resident class no later than the academic year (AY) immediately following the end of the grant. Applicants are expected to apply for ACGME accreditation or an RTP complement increase by the end of their second year of the grant.
13. What does it mean for family medicine programs to prepare residents for the independent practice of obstetrics?
For the family medicine programs with enhanced obstetrical training, 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. 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". For more information, see ACGME's family medicine program requirements.
14. How should I complete the table requirement for Attachment 1: Rural Status?
You must provide a table of all proposed training sites that includes the following key information:
- Site name and address
- County name and state
- County rural or urban status in the Fiscal Year 2025 (FY25) IPPS Final Rule
- Site rural status in the Rural Health Grants Eligibility Analyzer
- Site classification
- Projected percentage of resident training time at each site
There is a Sample table included in Appendix B on page 75 of the HRSA-25-007 funding opportunity. Each column in the sample table aligns to the bulleted list above. In the table, the CMS Rural Status column aligns with the County rural or urban status in the FY25 IPPS Final Rule. The FORHP rural status aligns with the site rural status in the Rural Health Grants Eligibility Analyzer. For site classification, choose one or more options from the list on page 40 of the funding opportunity. You may use the RRPD-TA Center's Rural GME Hospital Analyzer tool (registration required) as a starting point to site classification for your proposed training sites. This tool is for information purposes only. See pages 40-41 of the funding opportunity for more information about Attachment 1.