[Federal Register Volume 59, Number 28 (Thursday, February 10, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-3009]
[[Page Unknown]]
[Federal Register: February 10, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Tribal Management Program for American Indians/Alaska Natives:
Grants Application Announcement
AGENCY: Indian Health Service, HHS.
ACTION: Notice of competitive grant applications for tribal management
grants for American Indians/Alaska Natives.
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SUMMARY: The Indian Health Service (IHS) announces that competitive
grant applications are now being accepted for Tribal Management Grants
for American Indians/Alaska Natives. These grants are established under
the authority of section 103(b)(2) and section 103(e) of the Indian
Self-Determination and Education Assistance Act, Pub. L. 93-638, as
amended by Pub. L. 100-472, 25 U.S.C. 450h(b)(2). There will be only
one funding cycle during fiscal year (FY) 1994. This program is
described at 93.228 in the Catalog of Federal Domestic Assistance.
These grants will be awarded and administered in accordance with this
announcement; Department of Health and Human Services regulations
governing Pub. L. 93-638 grants at 42 CFR 36.101 et seq. and 45 CFR
part 92, Department of Health and Human Services, Uniform
Administrative Requirements for Grants and Cooperative Agreements to
State and Local Governments, or 45 CFR part 74, Administration of
Grants to Non-profit Recipients; the Public Health Service Grant Policy
Statement; and applicable Office of Management and Budget Circulars.
Executive Order 12372 requiring intergovernmental review is not
applicable to this program. Therefore, this program is not subject to
the Public Health System Reporting requirements as referenced in
Executive Order 12372. Public Health Service urges applicants
submitting feasibility studies or health plans to address specific
objectives of Healthy People 2000. Such interested applicants may
obtain a copy of Healthy People 2000 (Summary Report; Stock No. 017-
001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (Telephone 202-783-3238).
DATES: A. Application Receipt Date--An original and two (2) copies of
the completed grant application must be submitted with all required
documentation to the Grants Management Branch, Division of Acquisition
and Grants Operations, Twinbrook Building, suite 300, 12300 Twinbrook
Parkway, Rockville, Maryland 20852, by close of business March 28,
1994.
Applications shall be considered as meeting the deadline if they
are either: (1) Received on or before the deadline with hand carried
applications received by close of business 5 p.m. or (2) postmarked on
or before the deadline and received in time to be reviewed along with
all other timely applications. A legibly dated receipt from a
commercial carrier or the U.S. Postal Service will be accepted in lieu
of a postmark. Private metered postmarks will not be accepted as proof
of timely mailing. Late applications not accepted for processing will
be returned to the applicant and will not be considered for funding.
B. Additional Dates:
1. Application Review: April 25, 1994
2. Applicants Notified of Results: On or about June 17, 1994 (approved,
recommended for approval but not funded, or disapproved)
3. Anticipated Start Date: August 1, 1994.
CONTACTS FOR ASSISTANCE: For Tribal Management Grant program
information, contact Ms. Bea Bowman, Division of Community Services,
Indian Health Service, Parklawn Building, room 6A-05, 5600 Fishers
Lane, Rockville, Maryland 20857, (301) 443-6840. For grant application
and business management information, contact Mrs. Kay Carpentier,
Grants Management Branch, Indian Health Service, Twinbrook Building,
suite 100, 12300 Twinbrook Parkway, Rockville, Maryland 20852, (301)
443-5204. (The telephone numbers are not toll-free.)
SUPPLEMENTARY INFORMATION: This announcement provides information on
the general program purpose, eligibility and documentation, funding
priorities, project types, funds available, limitations, period of
support and application procedures for FY 1994.
A. General Program Purpose
The purpose of the Tribal Management Grant Program is to improve
the management capacity of a tribal organization to enter into a
contract under the Indian Self-Determination Act, Pub. L. 93-638.
Tribal management grants assist tribes and tribal organizations in
preparing to assume operation of all or part of an existing IHS direct
operated health care program by enabling them to develop and maintain
their management capabilities.
In addition, tribal management grants are available to any tribal
organization under the authority of Public Law 93-638 section 103(e)
for (1) obtaining technical assistance from providers designated by the
tribal organization, including tribal organizations that operate mature
contracts, for the purpose of program planning and evaluation,
including the development of any management systems necessary for
contract management, and the development of cost allocation plans for
indirect cost rates; and (2) planning, designing, and evaluating
Federal health programs serving the tribe, including Federal
administrative functions.
Tribal management grants may not be used to support operational
programs, or to supplement existing public and private resources. The
grants may, however, be used as matching shares for other Federal grant
programs that develop tribal capabilities to contract for the
administration and operation of health programs.
Note: Projects related to water, sanitation, waste management;
and long term care; tuition, fees, stipends for certification and
training of staff providing direct services; and design and planning
of construction for facilities will not be considered eligible for
review. Projects which include training and technical assistance on
the pending regulations for Indian Self-Determination and Education
Assistance Act, Pub. L. 93-638, as amended by Pub. L. 100-472, will
not be considered for funding. Inclusion of these activities in a
proposed project shall render the application ineligible and the
application will be returned to the applicant.
B. Eligibility and Documentation
Any federally recognized Indian tribe or Indian tribal organization
is eligible to apply for a grant, however, only one tribal management
grant will be awarded and funded to a tribe or tribal organization per
funding cycle. Eligible applicants include tribal organizations that
operate mature contracts who are designated by a tribe or tribes to
provide technical assistance and/or training.
The following documentation is required:
1. Documentation of new federally recognized/restored tribes--A
copy of the Federal Register Notice of letter from the Bureau of Indian
Affairs (BIA) verifying tribal status.
2. Tribal Resolution--(a) A resolution of the Indian tribe(s)
served by the project must accompany the application; (b) Applications
which propose projects to include more than one Indian tribe must
include resolutions from all tribes to be served; and (c) Applications
by tribal organizations will not require a specific tribal
resolution(s) if the current blanket tribal resolution(s) under which
they operate would encompass the proposed grant activities.
C. Funding Priorities
The IHS has established the following funding priorities for
awarding tribal management grants. Funding priorities were published
for public comment in the Federal Register on November 23, 1992, at 57
FR 54986 and retained with clarification as published on March 12, 1993
at 58 FR 13605.
Priority I
An Indian tribe that has received Federal recognition (new,
restored, unterminated, funded or unfunded) within the past three (3)
years and is preparing to contract under Pub. L. 93-638 to assume
operation of health care services.
Priority II
An Indian tribe or Indian tribal organization currently contracting
with IHS, with a stated intention to contract all or part of an
existing IHS operated service unit or health program. Applicants
meeting this profile must have current certified management systems,
i.e. BIA, IHS, or CPA certified; and resolutions of support from the
tribes to be served by the project in a multi-tribal service unit.
Priority III
An Indian tribe or Indian tribal organization stating an interest
in contracting IHS health programs for the first time. Applicants
meeting this profile must have current certified management systems,
i.e. BIA, IHS, or CPA certified; or respond within a specific time
period in the first quarter of the grant period to establish certified
management systems to begin receiving federal funds.
Priority IV
An Indian tribe or Indian tribal organization stating an interest
in planning, designing and evaluating Federal health programs serving
the tribe, including Federal administrative functions.
Priority V
An Indian tribe or Indian tribal organization currently contracting
IHS tribal programs, i.e., Community Health Representative program,
Alcohol programs, Emergency Medical Services, etc., and are seeking
improvement or expansion of existing tribal health management structure
without further contracting.
D. Project Types
The Tribal Management Grant Program consists of seven (7) types of
projects: (1) Feasibility studies, (2) planning, (3) development of
tribal health management structure, (4) human resources development,
(5) evaluation, (6) technical assistance and (7) Federal programs
analysis.
Note: The above listing of project types are not subject to
prioritization.
Applications shall address only one project type as opposed to a
combination of two or more project types.
Project Types Descriptions
1. Feasibility Study--a study of a specific IHS program or segment
of a program to determine if tribal management of the program is
possible. This study shall indicate necessary plans, approach, training
and resources required to assume tribal management of the program. The
study shall include a minimum of four (4) major components:
a. Health needs and health care services assessments, which
identify existing health care services and delivery system, program
division issues, health status indicators, unmet needs, volume
projections, and demand analysis.
b. Management analysis of existing management structure, proposed
management structure, implementation plans and requirements, and
personnel staffing requirements and recruitment barriers.
c. Financial analysis of historical trends data, financial
projections and new resource requirements for program and management
costs, and analysis of potential revenues from Federal/Non-Federal
sources.
d. Decision stage which incorporates findings; conclusions and
recommendations; and presentation of the feasibility study and
recommendations to the governing body to determine whether tribal
assumption of the health program(s) is desirable or warranted.
2. Plan--a collection of data to establish goals, policies, and
procedures for operation of tribal health programs. Health plans shall
specify IHS health programs and the priority order in which the tribe
will assume operation of these programs. A plan shall include a minimum
of four components:
a. Survey and analysis of the population's needs.
b. Prioritization of health needs and programs.
c. Statement of goals and objectives for each program to be
assumed.
d. Strategy including policies and procedures for tribal assumption
and operation of each program.
3. Development of Tribal Health Management Structure--creation or
enhancement and implementation of systems to manage, organize or direct
health programs. Management structures include health department
structure and organization, tribal health boards, systems for
accounting, personnel, third party billing, medical records, etc.,
upgrading to achieve accreditation through Joint Commission on
Accreditation of Health Organizations (JCAHO) or development of fiscal
and patient registration systems to meet requirements of Federally
Qualified Health Centers (FQHC). Management structure projects shall
include at minimum the following:
a. Description of existing structures.
b. Explanation of the purpose and design of the proposed management
structure.
c. Identification of improvements expected and impact of newly
created or enhanced management structure proposed.
d. Short range and long range strategies for tribal operation of
the management structure.
4. Human Resources Development--development of a particular skill
or group of skills required for tribal staff to manage or operate an
IHS program. The human resources development plan shall at minimum
include:
a. Training needs assessment and analysis of education, skills and
experience of current staff and future requirements.
b. Assessment of management and administrative competence required
to meet short range (1-2 years) and long range (not more than 5 years)
needs coupled with identification of organizational needs.
c. Identification of short range and long range management training
program.
5. Evaluation Studies--a systematic collection, analysis, and
interpretation of data to determine the value of current tribal health
programs. Evaluation studies shall at minimum include:
a. Effects of any previous studies as related to the goals and
objectives, policies and procedures, or programs on target groups.
b. A description of the current tribal health programs'
effectiveness and efficiency, including direct services, financial
management, personnel, data collection and analysis, third party
billing, etc.
c. Identification of what could be done to improve the health care
delivery system(s).
6. Technical Assistance--aid or help from providers designated by
the tribal organization, including tribal organizations that operate
mature contracts, for the purposes of program planning and evaluation,
including development of any management systems necessary for contract
management, and development of cost allocation plans for indirect cost
rates. For example, an Indian tribe or Indian organization may wish to
seek technical assistance from a tribe to develop a managed care
component for a direct service delivery system.
7. Federal Programs Analysis--projects focused on planning,
designing and evaluating Federal programs serving the tribe, including
Federal administrative functions. For example a tribe or tribal
organization may wish to evaluate IHS direct services programs such as
Contract Health Services, Mental Health, Public Health Nursing, etc.
E. Funds Available, Limitations and Period of Support
1. Funds available--It is anticipated that approximately $5,000,000
will be available for approximately 75 new and continuation grants
averaging $67,000 each. Grant funding levels include both direct and
indirect costs.
2. Limitations--Only one grant project will be awarded per tribe or
tribal organization. A current tribal management grantee whose project
will not be completed within the current grant period will not be
awarded new, renewal or competing continuation grants.
3. Period of support--(a) feasibility studies and planning projects
are limited to one year (12 months) funding; (b) projects regarding
tribal management structure, human resources development, evaluation,
technical assistance, and Federal programs analysis may be funded up to
three (3) years in annual budget periods depending upon the defined
scope of work.
F. The Tribal Management Grant Application Kit
A Tribal Management Application Kit, including the required PHS
form and Narrative PHS 5161-1 (Rev. 7/92) (OMB Approval No. 0937-0189)
and the U.S. Government Standard forms (SF-424, SF-424A and SF-424B),
may be obtained from the Grants Management Branch, Division of
Acquisition and Grants Operations, IHS, Twinbrook Metro Plaza, suite
100, 12300 Twinbrook Parkway, Rockville, MD 20852, telephone (301) 443-
5204. (Note: This is not a toll free number.)
G. Grant Application Requirements
All applications must be singled-spaced, typewritten, and
consecutively numbered pages using black type not smaller than 12
characters per one inch, with conventional border margins, on only one
side of standard size 8\1\/\2\ x 11 paper that can be photocopied.
All applications must include the following in the order presented:
--Tribal Resolution(s) and Documentation (B. Eligibility and
Documentation),
--Standard Form 424, Application for Federal Assistance,
--Standard Form 424A, Budget Information--Non-Construction Programs,
(pages 1 and 2),
--Standard form 424B, Assurances--Non-Construction Programs (front and
back),
--Checklist (pages 23-24) Note: Each standard form and the checklist is
contained in the PHS Grant Application, Form PHS 5161-1 (Revised 7/92),
--A one-page project abstract (H. 1.),
--A table of contents (H. 2.),
--Introduction (H. 3.),
--Need for Assistance (H. 4.),
--Objective(s), Results, and Benefits Expected (H. 5),
--Approach (H. 6.),
--Evaluation (H. 7),
--Key Personnel (H. 8.),
--Budget Justification and Management Controls (H. 9), and
--Appendix to include:
*Resumes (Curriculum Vitae) of key staff,
*Position descriptions for key staff,
*Organizational chart,
*Copy of current negotiated indirect cost rate agreement,
*A map of the area to benefit from the project,
*A copy of the survey instrument, if used.
*Application Receipt Card, PHS--3038-1 Rev. 5-90.
H. Application Narrative Instructions, Application Standards (Criteria)
and Weights
The following instructions for preparing the application narrative
also constitute the standards (criteria or basis for evalaution) for
reviewing the application to approve or disapprove. Weights assigned
each section are noted in parenthesis.
1. Abstract--An abstract may not exceed one typewritten page. The
abstract should clearly present the application in summary form, from a
``who-what-when-where-how-cost'' point of view so that reviewers see
how the multiple parts of the application fit together to form a
coherent whole.
2. Table of Contents--Provide a one page typewritten table of
contents.
Narrative: Please describe the complete project in clear and
succinct language as application reviewers may have little or no
knowledge regarding the tribe or tribal organization. It should be
organized as described in this section, should not exceed 25 single
spaced pages, and address the following: (Note: Application narratives
exceeding 25 pages will not be accepted for review.)
3. Introduction (5 pts.)
a. Identify the funding priority and justify the priority selected.
b. Identify the type of project.
c. State the type (specific or blanket) and date of resolution
submitted with the application. (Refer to B. Eligibility and
Documentation).
d. Describe the population to be served by management of tribal
health programs and the number of eligible beneficiaries.
e. Provide a precise location of the project and area to be served
by the proposed project including a map (include the map in the
appendix).
4. Need for Assistance (10 pts.)
a. Explain the reason for the project.
b. Describe the tribe's current health operations including whether
the tribe has a health department, how long it has been operating, what
programs or services are currently provided and indicate
accomplishments using statistics if available.
c. Describe the overall and specific need for assistance by
explaining the current and past situation or demand and unmet need
(i.e., resources, staffing, equipment, training, etc.).
d. Identify relevant environmental, economic, social, financial or
organizational programs requiring solutions.
e. Include relevant statistical data to support the need and
include examples.
f. Describe the relationship between this project and other
federally funded work planned, anticipated, or underway.
g. Identify all previous and/or current tribal management grants
received, dates of funding, and project accomplishments (Do not include
copies of reports).
5. Objective(s) Results and Benefits Expected (20 pts.)
a. State is measurable terms, realistic principal and subordinate
objectives of the project.
b. Identify the expected results, benefits and outcome or product
to be derived from each objective of the project.
c. Identify who will do what, when, and how, relating to the
anticipated outcome of the project.
6. Approach (20 pts.)
a. Outline and describe the major tasks and activities with the
objective(s) to be achieved.
b. Include a workplan with start, target milestones and completion
dates on a calendar timeline.
c. Discuss present or proposed staffing of the project. Position
descriptions for key personnel must be included in the Appendix.
d. Describe data sources, management, quality control, and analysis
by addressing:
1. Data to be collected, by whom, and time intervals in the
project,
2. Data sources and how access to the sources will be attained,
3. Procedure to collect, receive, code and prepare the data for
analysis,
4. How data will be kept confidential and secure,
5. Contingency plan for low response rates,
6. How completeness and accuracy of data will be measured and
assured.
7. Plan for statistical or non-statistical analyses of data,
8. Include a copy of survey instrument(s), if used.
e. If use of consultants or contractors is proposed or anticipated,
provide a detailed scope of work which clearly defines the deliverable
or outcomes anticipated; and qualifications and experience
requirements.
f. Identify who will review and accept the work products of the
project deliverable/outcomes, including work to be performed by
consultants or contractors.
7. Evaluation (15 pts.)
a. State how it will be determined if the project's objectives were
achieved and how the accomplishment of those objectives can be
attributed to the project.
b. Discuss the criteria to be used to evaluate results and
benefits.
c. Explain the methodology that will be used to determine if the
needs identified for the project are being met and if the project's
outcomes identified are being achieved.
8. Key Personnel (15 pts.)
a. Provide job position descriptions and resumes (if applicable)
for key staff.
b. Identify qualifications and experience requirements for
consultants or contractors if use is anticipated.
c. State the tribe's approved Indian Preference policy.
9. Budget Justification and Management Control (15 pts.)
a. Provide a budget justification in accordance with the budget
narrative instructions contained on page 21 of form PHS 5161-1
b. Describe where the project will be housed, i.e., facilities and
equipment available.
c. List equipment and software purchases necessary for
implementation of the project; include descriptive rationale and
justification for computer hardware/software.
d. Describe the management control of the tribe/tribal organization
over the direction and acceptability of work to be performed by the
consultant or contractor.
e. Provide documentation of current certified financial management
system, i.e. BIA, IHS, or CPA certified.
f. If a first-time applicant, include a plan to meet the special
requirement of establishing certified management systems to begin
receiving Federal funds.
g. If indirect cost are claimed, applicant must submit a copy of
Indirect Cost Rate Agreement supporting this claim.
10. Multi-year Projects--projects requiring a second or third year
must include a program narrative and categorical budget and
justification for each additional year of funding requested.
11. Appendix--to include:
a. Current approved organizational chart,
b. Resumes and job descriptions for key staff,
c. Copy of current negotiated indirect cost rate agreement,
d. A map of the area to benefit from the project,
e. A copy of the survey instrument, if used, and
f. Application receipt card, PHS 3038-1 Rev. 5-90.
I. Assurances
The application shall contain assurances to the Secretary that the
applicant will comply with program regulations, 42 CFR part 36 subpart
H.
J. Reporting
1. Program Report--Program progress reports will be submitted
quarterly. These reports will include a brief description of a
comparison of actual accomplishments to the goals established for the
period, reasons for slippage and other pertinent information as
required. A final report is due 90 days after expiration of the budget/
project period.
2. Financial Status Report--Quarterly financial status reports will
be submitted 30 days after the end of the quarter. Final financial
status reports are due 90 days after expiration of the budget/project
period. Standard Form 269 (long form) will be used for financial
reporting.
K. Grant Administration Requirements
Grants are administered in accordance with the following documents:
1. 45 CFR part 92, Department of Health and Human Services, Uniform
Administrative Requirements for Grants and Cooperative Agreements to
State and Local Governments, or 45 CFR part 74, Administration of
Grants to Non-profit recipients.
2. Public Health Service Grant Policy Statement, and
3. Appropriate Cost principles: OMB Circular A-87, State and Local
Governments, or OMB Circular A-122, Non-profit Organizations.
L. Objective Review Process
Applications meeting eligibility requirements that are complete and
conform to this program announcement will be reviewed by a centralized
Ad Hoc Objective Review Committee (ORC) appointed by IHS primarily for
review of these applications. The review will be conducted at the IHS
Headquarters and in accordance with IHS objective review procedures.
The objective review process ensures nationwide competition for limited
funding. The ORC will be comprised of IHS (40% or less) and other
federal or non-federal individuals (60% or more) with appropriate
expertise. The ORC will review each application against established
criteria. Based upon the evaluation criteria, the reviewers assign a
numerical score to each application, which will be used in making the
final funding decision. Applications scoring less than 60 points will
be considered technically unacceptable and will be disapproved.
M. Application Standards Qualitative Rating Factors
1.0=Excellent--very comprehensive, in-depth clear response. The
application meets this standard with no omissions. Consistently high
performance can be expected.
0.8=Very Good--extensive, detailed application similar to excellent
in quality, but with minor areas requiring additional clarification.
High quality performance is likely, but not assured due to minor
omissions or areas where less than excellent performance might be
expected.
0.6=Good--no deficiencies in the response. Better than acceptable
performance can be expected, but in some significant area there is lack
of clarity which might impact on performance.
0.4=Fair--the response generally meets minimum standards. Existing
deficiencies are confined to areas with minor impact on performance and
can be corrected without revision.
0.2=Marginal--deficiencies exist in significant areas. The
application can be corrected without major revision or serious
deficiencies exist in areas with minor impact.
0.0=Unsatisfactory--serious deficiencies exist in significant
areas. The project cannot be expected to meet minimum requirements
without revisions. The application only indicates a willingness to
perform a project without specifying how or demonstrating the capacity
to do so. Only vague indications exist regarding capability.
N. Results of the Review
The results of the objective Review are forwarded to the Associate
Director, Office of Tribal Activities, for final review and approval.
Applicants are notified of their approval or approval without funds, on
or about June 17, 1994. A Notice of Grant Award will be issued
approximately ten (10) days prior to the start date of August 1, 1994.
Unsuccessful applicants are notified in writing of disapproval not
later than June 17, 1994. A brief explanation of the reasons the
application was not approved is provided along with the name of an IHS
official to contact if more information is desired.
Dated: December 10, 1993.
Michel E. Lincoln,
Acting Director.
[FR Doc. 94-3009 Filed 2-9-94; 8:45 am]
BILLING CODE 4160-16-M
