[Federal Register Volume 61, Number 40 (Wednesday, February 28, 1996)]
[Notices]
[Pages 7525-7527]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-4477]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Special Projects of National Significance; Integrated Service
Delivery Models
AGENCY: Health Resources and Services Administration, HHS.
ACTION: Notice of Availability of Funds.
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SUMMARY: The Health Resources and Services Administration (HRSA)
announces that applications will be accepted for fiscal year (FY) 1996
Grants for Special Projects of National Significance (SPNS) funded
under the authority of Section 2618(a) of the Public Health Service
Act, as established by the Ryan White Comprehensive AIDS Resources
Emergency (CARE) Act of 1990, Public Law 101-381, dated August 18,
1990. This announcement solicits applications addressing integrated
service delivery for persons with HIV disease. Under this announcement,
applicants must respond to one of the two categories delineated in the
section entitled, ``Description of Categories''. Applicants can apply
for project periods of up to 5 years. The SPNS program, in
collaboration with the SPNS funded HIV Evaluation Technical Assistance
Center grantee, will provide technical assistance and support for
project's program evaluation studies.
This program announcement is subject to the appropriation of funds.
Applicants are advised that this program announcement is a contingency
action being taken to assure that should funds become available for
this purpose, they can be awarded in a timely fashion consistent with
the needs of the program as well as to provide for an even distribution
of funds throughout the fiscal year. At this time, given a continuing
resolution and the absence of FY 1996 appropriations for the Ryan White
CARE Act programs, the amount of available funding for these specific
grant programs cannot be estimated.
The SPNS program is designed to demonstrate and evaluate innovative
and potentially replicable HIV service delivery models. The authorizing
legislation specifies three SPNS program objectives: (1) To assess the
effectiveness of particular models of care; (2) to support innovative
program design; and (3) to promote replication of effective models.
DATES:
Notification
In order to allow HRSA to plan for the Objective Review Process,
applicants are encouraged to contact the grants office in writing to
notify HRSA of their intent to apply. This notification serves to
inform HRSA of the anticipated number of applications and the category
(and sub-category, if applicable) in which applications are being
submitted. If notification is offered, it should be received within 30
days after publication of the Notice of Availability of Funds in the
Federal Register. The address is: Grants Management Branch; Bureau of
Health Resources Development; Health Resources and Services
Administration; Room 7-15; Rockville, MD 20857.
Application
Applications for these announced grants must be received in the
Grants Management Branch by the close of business May 28, 1996, to be
considered for competition. Applications will meet the deadline if they
are either: (1) received on or before the deadline date; or (2)
postmarked on or before the deadline date, and received in time for
submission to the objective review panel. A legibly dated receipt from
a commercial carrier or U.S. Postal Service will be accepted as proof
of timely mailing. Applications received after the deadline will be
returned to the applicant.
ADDRESSES: Grant applications, guidance materials, and additional
information regarding business, administrative, and fiscal issues
related to the awarding of grants under this Notice may be requested
from Mr. Neal Meyerson, Grants Management Branch, Bureau of Health
Resources Development, Health Resources and Services Administration,
5600 Fishers Lane, Room 7-15, Rockville, MD, 20857. The telephone
number is (301) 443-2280 and the FAX number is (301) 594-6096.
Applicants for grants will use Form PHS 5161-1, approved under OMB
Control No. 0937-0189. Completed applications should be sent to the
Grants Management Branch.
FOR FURTHER INFORMATION CONTACT: Additional technical information may
be obtained from the SPNS Branch, Office of Science and Epidemiology,
Bureau of Health Resources Development, Health Resources and Services
Administration, 5600 Fishers Lane, Room 7A-07, Rockville, MD 20857. The
telephone number is (301) 443-9976 and the FAX number is (301) 594-
2511.
HEALTHY PEOPLE 2000 OBJECTIVES: The Department of Health and Human
Services (DHHS) urges applicants to address specific objectives of
Healthy People 2000 in their work plans. Potential applicants may
obtain a copy of Healthy People 2000 (Full Report; Stock No. 017-001-
00474-0) or Healthy People 2000 (Summary Report; Stock No. 017-001-
00473-1) through the Superintendent of Documents, Government Printing
Office, Washington, DC 200402-9325 (Telephone 202-783-3238).
SUPPLEMENTARY INFORMATION:
Background and Objectives
The SPNS program endeavors to advance knowledge and skills in HIV
services delivery, stimulate the design of innovative models of care,
and support the development of effective delivery systems for these
services. SPNS accomplishes its purpose through funding and technical
support of innovative HIV service delivery models. For purposes of this
announcement, models seeking SPNS support must address one of the two
categories described below.
In establishing the current special project categories,
consideration was given to priority service areas identified in the
SPNS concept paper, Future Directions: Increasing Knowledge about
Health and Support Service Delivery to People with HIV Disease. This
document was developed through interviews with and written comments
from, key HRSA staff and experts inside and outside the U.S. Public
Health Service, following a review of relevant HIV-related service
delivery, research, evaluation, policy and planning documents.
Consideration was also given to recommendations expressed during the
1995 White House Conference on HIV and AIDS. Participants in the White
House Conference and others recommended that collaborative efforts be
made by the Departments of Health and Human Services and Housing and
Urban Development to integrate funding streams for projects that
address the needs of clients with multiple diagnoses.
The SPNS program supports innovative projects for which
implementation, utilization, costs, and outcomes can be evaluated
rigorously.
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Proposals will be expected to adequately define and justify the need,
innovative nature, and evaluation methodology of the proposed model of
services. These funds should be used to create and/or evaluate models
of care that would likely not exist nor be evaluated without SPNS
support, or that would extend the care model to previously underserved
or unserved populations defined either geographically or
demographically.
SPNS funds cannot be used for expenses related to the provision of
medical care; supportive services; or any other expenses currently
reimbursed, subsidized or eligible for reimbursement through third
party payers, grants awarded under Titles I-IV of the Ryan White CARE
Act, or other grant and foundation sources.
Description of Categories
The Special Project Categories for FY 1996 will support the
development and evaluation of models of care that address the formal
linkage and integration of HIV ambulatory medical care (including
primary medical care, mental health, substance abuse treatment and/or
other critical HIV services).
Applications will be accepted that propose to demonstrate and
evaluate:
Category A--Models of Integrated Service Delivery for Persons with HIV
Disease
The formal linkage and integration of mental health, substance
abuse treatment, rehabilitation and/or other critical HIV services with
HIV ambulatory medical care (such as primary medical care and/or home/
health care) in new or existing projects. Projects may provide
comprehensive services to people with HIV disease in locations or
facilities or clinics that serve only people with HIV disease or those
that also care for people who do not have HIV disease. Where
applicable, project evaluations should compare client and provider
outcomes and satisfaction with care for HIV infected clients receiving
care in HIV specific provider sites as compared to HIV infected clients
receiving care in non-HIV specific settings.
Applicants for this category must address one of the following sub-
categories:
(1) Coordinated delivery of HIV health and support services to
specified transient, homeless, migrant, immigrant or mobile populations
to ensure the delivery of a comprehensive continuum of care throughout
the course of HIV infection and disease;
(2) Delivery of comprehensive health and support services to Native
Americans (such as American Indians, Alaskan Natives or Native
Hawaiians) through a network of providers experienced in caring for
Native American communities; or
(3) Development of an integrated system of HIV ambulatory medical
care services for an unserved or underserved population group that is
experiencing a significant barrier(s) to care (e.g., ethnic and
language minorities, visually or hearing impaired communities, the
severely and persistently mentally ill, rural communities, or others)
that improves access to and retention in the health care delivery
system.
Category B--The Multiple Diagnoses Initiative
This initiative, a collaborative effort between the Departments of
Health and Human Services (HHS) and Housing and Urban Development
(HUD), is designed to develop and evaluate programs for the integration
of medical, substance abuse, mental health services and other support
services with housing assistance for homeless persons with HIV/AIDS and
a serious mental illness and/or alcohol or substance abuse problems.
The collaboration targets ``on the street'' homeless persons who
currently do not have a place to live. This would include an innovative
strategy for developing an integrated system of outreach, needs
assessment, comprehensive health and other support services and various
types of transitional and permanent housing which has the potential for
replication. Related assistance is being announced under the Special
Projects of National Significance component of HUD's Housing
Opportunities for Persons with AIDS (HOPWA) program. For further
information about HUD assistance, please contact Fred Karnas, Office of
HIV/AIDS Housing, Community Planning and Development, 451 Seventh
Street, SW, Room 7154, Washington, DC, 20410-7000. The telephone number
is 202-708-1934 and the FAX number is 202-708-1744.
Review Criteria
Applications submitted to the SPNS program under this announcement
will be reviewed and rated by an objective review panel. Criteria for
the technical review of applications will include the following
factors:
Factor 1: Justification of Need (15 points) Adequacy of
demonstrated knowledge of the local HIV service delivery system and the
adequacy of the justification of need within the community and target
population for the proposed integration model. The extent to which the
applicant's justification of need goes beyond documenting the existence
of an available population in need of HIV services and describes what
is innovative about the proposed model, how this model will be of
benefit to the population in need, and its potential to advance
knowledge in the HIV service delivery field. The adequacy of the
discussion about whether or not this or similar models have been
evaluated in published literature or reports. The extent to which the
applicant identifies past/existing/future systemic or programmatic
issues that have contributed to a fragmented service delivery system
and how this model will develop a more integrated system of care.
Factor 2: Description of Proposed HIV Service Integration Model (25
points) The extent of the feasibility and clarity of the description,
appropriateness, innovative quality, and potential for evaluation,
replication and dissemination of the proposed model. The amount of
emphasis given to the definitive integration of services to ensure the
delivery of a comprehensive spectrum of care to persons with HIV
disease. The extent to which the identification of providers and
services integrated by the model is described. The adequacy of the
discussion of the rationale for the selection of providers and services
integrated by the proposed model.
Factor 3: Description of Program Plan (20 points) Comprehensiveness
of the program plan as described in clearly stated goals, time-limited
and measurable objectives for each goal, activities directly related to
each objective, and a time line that shows the schedule of activities
and production of materials that corresponds to milestones stated in
the objectives and program evaluation. The extent to which the
applicant demonstrates access to the proposed target population. The
feasibility of the description of a process for maintaining client
confidentiality throughout the project period.
Factor 4: Description of Evaluation Plan (20 points) Thoroughness,
feasibility and appropriateness of the project's evaluation design from
a methodological and statistical perspective. The extent to which the
design of the evaluation allows a generalized conclusion regarding the
outcomes of the integration model and its suitability for replication.
The adequacy of the plan to assess HIV-related health outcomes among
the population serviced and followed, and
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the anticipated outcome impact from a systems level perspective.
Factor 5: Description of Dissemination (10 points) The extent to
which the applicant demonstrates past involvement with disseminating
information about HIV service delivery by describing dissemination
activities to date (e.g., presenting and publishing findings through
reports and papers, training, or technical assistance). The adequacy
and feasibility of the preliminary dissemination plan.
Factor 6: Description of Organizational Capacity (10 points)
Competency of the applicant organization in terms of fiscal, program
management, and evaluation, as evidenced by (a) the consistency between
the proposed level of effort and the budget justification; (b) skill
level and time commitment required in the personnel specifications for
program and evaluation staff; (c) the adequacy of resources proposed to
conduct a quality evaluation of the project and dissemination of the
project's findings; (d) the qualifications and experience of the
proposed evaluation staff; and (e) appropriate confidential handling of
clients' medical, social service, and epidemiological data. Extent of
documentation demonstrating current and proposed coordination, formal
collaboration, and specific linkages with related medical, health and
support service activities within the project's catchment area.
Other Grant Information
Allowable Costs
The basis for determining allocable and allowable costs to be
charged to PHS grants is set forth in 45 CFR part 74, subpart Q and 45
CFR part 92 for State, local or tribal governments. The four separate
sets of cost principles prescribed for public and private non-profit
recipients are OMB Circular A-87 for State, local or tribal
governments; OMB Circular A-21 for institutions of higher education; 45
CFR part 74, appendix E for hospitals; and OMB Circular A-122 for
nonprofit organizations.
Reporting and Other Requirements
A successful applicant under this notice will submit semi-annual
activity summary reports in accordance with provisions of the general
regulations which apply under 45 CFR part 74, subpart 74.51,
``Monitoring and Reporting Program Performance,'' with the exception of
State and local governments to which 45 CFR part 92, Subpart C
reporting requirements apply. Also, grantees must be prepared to
collaborate with other grantees on the design and implementation of
project evaluations which may include multi-site evaluation studies.
Public Health System Reporting Requirements
This program is subject to the Public Health System Reporting
Requirements which have been approved by the Office of Management and
Budget under No. 0937-0195. Under these requirements, any community-
based, non-governmental applicant must prepare and submit a Public
Health System Impact Statement (PHSIS). The PHSIS is intended to keep
State and local health officials apprised of proposed health services
grant applications submitted from within their jurisdictions.
Community-based, non-governmental applicants are required to
submit, no later than the Federal due date for receipt of the
application, the following information to the administrator of the
State and local AIDS programs in the area(s) to be impacted by the
proposal: (a) A copy of the face page of the application (SF424); and,
(b) a summary of the project (PHSIS), not to exceed one page, which
provides: (1) A description of the population to be served; (2) a
summary of the services to be provided; and, (3) a description of the
coordination planned with the appropriate State or local health
agencies. Copies of the letters forwarding the PHSIS to these
authorities must be contained in the application materials submitted to
this program.
Certification Regarding Environmental Tobacco Smoke
The Public Health Service strongly encourages all grant and
contract recipients to provide a smoke-free workplace and to promote
the non-use of all tobacco products. In addition, Public Law 103-227,
the Pro-Children Act of 1994, prohibits smoking in certain facilities
(or in some cases, any portion of a facility) in which regular or
routine education, library, day care, health care or early childhood
development services are provided to children.
Executive Order 12372
The Special Projects of National Significance Grant Program has
been determined to be a program subject to the provisions of Executive
Order 12372, as implemented by 45 CFR part 100. Executive Order 12372
allows States the option of setting up a system for reviewing
applications from within their States for assistance under certain
Federal programs. The application packages to be made available under
this notice will contain a listing of States which have chosen to set
up a review system and will provide a State Single Point of Contact
(SPOC) in the State for the review. Applicants (other than federally
recognized Indian tribes) should contact their SPOCs as early as
possible to alert them to the prospective applications and receive any
necessary instructions on the State process. For proposed projects
serving more than one State, the applicant is advised to contact the
SPOC of each affected state. The due date for State process
recommendations is 60 days after the appropriate deadline dates. The
Health Resources and Services Administration does not guarantee that it
will accommodate or explain its responses to State process
recommendations received after the due date. (See ``Intergovernmental
Review of Federal Programs,'' Executive Order 12372, and 45 CFR part
100, for a description of the review process and requirements.)
OMB Catalog of Federal Domestic Assistance
Number for the Special Projects of National Significance is 93.928.
Dated: February 14, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-4477 Filed 2-27-96; 8:45 am]
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