[Federal Register Volume 59, Number 53 (Friday, March 18, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6283]
[[Page Unknown]]
[Federal Register: March 18, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[RIN-0905-ZA07; PN#2178
Rural Telemedicine Grant Program
AGENCY: Health Resources and Services Administration (HRSA), Public
Health Service (PHS).
ACTION: Notice of availability of funds.
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SUMMARY: The Office of Rural Health Policy, HRSA, announces that
applications are being accepted for Rural Telemedicine Grants to (1)
develop a base of information for conducting a systematic evaluation of
telemedicine systems serving rural areas; and (2) facilitate
development of rural health care networks through the use of
telemedicine. Awards will be made from funds appropriated under Public
Law 103-112 (HHS Appropriation Act for FY 1994). Grants for these
projects are authorized under section 301 of the Public Health Service
Act.
National Health Objectives for the Year 2000
The 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 Rural Telemedicine Grant
program is related to the priority areas for health promotion, health
protection, and preventive services. Potential applicants may obtain a
copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-C) or
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).
Funds Available
Approximately $4.0 million is available for the Rural Telemedicine
Grant program in FY 1994. With these funds, the Office of Rural Health
Policy expects to make approximately eight awards for one year.
Applicants may propose project periods for up to three years. However,
applicants are advised that continued funding of grants beyond the one-
year period supported under this announcement is subject to
appropriation of funds and assessment of grantee performance. The start
date for the new projects will be September 30, 1994.
Funding Limits
Individual grant awards under this notice will be limited to a
total amount of $500,000 (direct and indirect costs) per year.
Applications for smaller amounts are strongly encouraged. Equipment
costs up to 40 percent of the total grant award are allowable. However,
the costs of purchasing and installing transmission equipment, such as
laying cable or telephone lines, microwave towers, digital switching
equipment, amplifiers, etc., are not allowable. Transmission costs are
allowable. Indirect costs are allowable up to 20 percent of the total
grant award.
Grant funds may not be used for construction, except for minor
renovations related to the installation of equipment. Grant funds may
not be used to acquire or build real property.
Cost Participation
Cost participation serves as an indicator of community and
institutional support for the project and of the likelihood that the
project will continue after Federal grant support has ended. Applicants
are required to demonstrate cost participation in the form of
equipment, personnel, building space, indirect costs, other in-kind
contributions, or cash.
DATES: Applications for the program must be received by the close of
business on May 20, 1994.
Applications shall be considered as meeting 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
orderly processing. Applicants must obtain a legible dated receipt from
a commercial carrier or the U.S. Postal Service in lieu of a postmark.
Private metered postmarks will not be acceptable as proof of timely
mailing. Late applications will be returned to the sender.
ADDRESSES: Requests for grant application kits should be directed to
Monte Parham, Office of Rural Health Policy, 301-443-0835. Requests for
additional information regarding business or fiscal issues, and
completed applications, should be directed to: Opal McCarthy, Grants
Management Office, Bureau of Primary Health Care, West Tower, 11th
floor, 4350 East West Highway, Rockville, MD 20857, (301) 594-4260. The
standard application form and general instructions for completing
applications (Form PHS-5161-1, OMB 0937-0189) have been approved by the
Office of Management and Budget (OMB).
FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic
information on this announcement should be directed to Carole Mintzer
or Cathy Wasem, Office of Rural Health Policy, 5600 Fishers Lane, Room
9-05, Rockville, MD 20857, (301) 443-0835.
SUPPLEMENTARY INFORMATION:
Program Objectives
The purpose of the program is to demonstrate and collect
information on the feasibility, costs, appropriateness, and
acceptability (to practitioners and patients) of telemedicine for
improving access to health services for rural residents and reducing
the isolation of rural practitioners. Grants will be awarded for
implementing and operating telemedicine systems that link multi-
specialty entities with rural health care facilities for the purposes
of delivering health care services to the rural sites and exchanging
information between the sites.
A central goal of the program is to demonstrate how telemedicine
can be used as an effective tool in the development of integrated
systems of health care. Integrated systems of care provide
comprehensive, coordinated health care services to the rural residents
served by the system through referrals, consultations, and support
systems that ensure patient access to a comprehensive set of services
and reduce practitioner isolation. In particular, the program is to
promote systems of health care in rural areas that link rural primary
care practitioners with specialty and referral services.
For the purposes of this grant program, telemedicine is defined as
the use of telecommunications for medical diagnosis and patient care. A
clinical consultation is defined as a person-to-person interaction
relating to the clinical condition or treatment of the patient. The
consultation could be between two practitioners, with or without the
patient present, or between a specialty practitioner and a patient.
In order to compete for the program, applicants must participate in
a telemedicine network that includes at least three sites: A
multispecialty entity (tertiary care hospital, multi-specialty clinic,
or a collection of facilities that, combined, could provide 24-hour a
day specialty consultations), a small rural hospital (fewer than 100
beds), a rural primary care practitioner office or clinic. Networks
that include a long-term care facility are especially encouraged. The
network may include additional rural sites, such as mental health
clinics, school-based clinics, emergency service providers, home health
providers, community and migrant health centers, rural health clinics,
Federally qualified health centers, health professions schools, etc.
The telemedicine network must be used to provide clinical consultations
between the multispecialty entity (hub) and the rural sites (spokes).
Projects that use low cost technologies are particularly encouraged.
For purposes of this grant program, a telemedicine network is
characterized by a full partnership among all the members that includes
the following elements: (1) Resource participation; (2) a specific role
for each member; (3) a contractual relationship; (4) a long-term
commitment to the project by each member; (5) documentation of the
network's activities; and (6) active participation by each member so
that the network is not solely dependent on any particular member
organization.
The applicant must be willing to participate in an evaluation of
telemedicine services. This may include, but is not limited to,
collecting data, completing surveys, and participating in on-site
observations by independent evaluators.
In order to facilitate an evaluation of telemedicine, it is
important that there be some level of uniformity in the types of
clinical services provided among the projects. All projects, at a
minimum, must be able to provide teleconsultations in the following
services: Teleradiology, cardiology, dermatology, mental health and/or
substance abuse, obstetrics and gynecology, orthopedics, subspecialties
of pediatrics, and resuscitation of trauma patients. Applicants may
propose to provide teleconsultations for additional services.
This grant program is intended to support telemedicine for medical
diagnosis and treatment of patients, including patient counseling. It
is not for didactic distance learning programs, such as lectures or
other programs designed solely for the purposes of instructing health
care personnel or patients.
Applicants must develop projects to address specific, well-
documented needs of the rural communities. In doing so, applicants are
advised to consider both the health care needs of the rural communities
served by the project, and the extent to which the project can build
upon existing telecommunications capacity in the communities to
facilitate efficient use of that capacity by multiple users. Needs can
be established through a formal needs assessment or by population
specific demographic data.
All the grant funding must be used for services provided to or in
rural communities. A majority of grant dollars must actually be spent
in rural communities for direct services to those communities,
including salaries, maintenance of equipment, and transmission costs.
Eligible Applicants
A grant award will be made only to an entity that is part of a
telemedicine network and can provide a wide range of specialty
consultation services on a 24-hour basis to rural spoke sites. The
grant recipient can be a public (non-Federal) or private entity located
in either a rural or urban area. Rural spoke sites may be public or
private entities, either nonprofit or for-profit. All spoke facilities
supported by this grant must meet one of the two requirements stated
below.
(1) The facility is located outside of a Metropolitan
Statistical Area as defined by the OMB. A list of the cities and
counties that are designated as being within a Metropolitan
Statistical Area will be included with the application kit.
(2) The facility is located in a rural census tract of one of
the counties listed in Appendix I to this announcement. Although
each of these counties is a Metropolitan Statistical Area, or part
of one, large parts of the counties are rural. Facilities located in
these rural areas are eligible for the program. Rural portions of
these counties have been identified by census tract since this is
the only way we have found to clearly differentiate them from urban
areas in the large counties. Appendix I provides a list of these
census tracts for each county. Appendix II includes the telephone
numbers for regional offices of the Census Bureau. Applicants may
call these offices to determine the census tract in which they are
located.
Review Procedure
Applications will be assessed by the Office of Grants Management
for responsiveness to this notice. Any applications that are judged
nonresponsive because they are inadequately developed, in an improper
format, exceed the specified page length, or otherwise are unsuitable
for peer review and funding consideration, will be returned without
further consideration. All responsive applications will undergo
objective peer review.
Review Consideration
Grant applications will be evaluated on the basis of the following
criteria:
(1) The extent to which the project facilitates development of
an integrated system of care for the rural areas served by the
project by providing referral linkages, facilitating consultations
among health care professionals, and reducing the isolation of
health care practitioners.
(2) The strength of the relationships among members of the
telemedicine network as demonstrated by the contractual
arrangements.
(3) A demonstrated ability to collect data and participate in an
evaluation of telemedicine.
(4) A demonstrated capability, experience, and knowledge of the
applicant and others who will be responsible for the project to
carry out the project.
(5) The reasonableness of the budget proposed for the project.
(6) The level of local commitment and involvement with the
project, including the extent of cost participation by the applicant
and/or other organizations.
(7) The extent to which the applicant has justified and
documented the need(s) for the project and developed measurable
goals and objectives for meeting the need(s).
(8) The feasibility of plans to continue the project after
Federal grant support has ended.
(9) The extent to which the proposed project would be capable of
replication in rural areas with similar needs and characteristics,
particularly with regards to its affordability by other communities.
Other Information
Applicants are advised that the narrative description of their
program and the budget justification may not exceed 30 pages in length.
Applications that exceed the 30 page limit for the program narrative
and budget justification will not receive consideration. All
applications must be typewritten and clearly legible, using print no
smaller than 12 characters per inch and having no less than one-half
inch margin on all sides.
Public Health System Impact Statement
This program is subject to the Public Health System Reporting
Requirements. Reporting requirements have been approved by the OMB--
0937-0195. Under these requirements, the community-based
nongovernmental applicant must prepare and submit a Public Health
System Impact Statement (PHSIS). The PHSIS is intended to provide
information to State and local health officials to keep them apprised
of proposed health services grant applications submitted by community-
based nongovernmental organizations within their jurisdictions.
Community-based non governmental applicants are required to submit
the following information to the head of the appropriate State and
Local health agencies in the area(s) to be impacted no later than the
Federal application receipt due date: a. A copy of the face page of the
application (SF 424) 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.
(3) A description of the coordination planned with the
appropriate State of local health agencies.
Executive Order 12372
The Rural Telemedicine Grant program has been determined to be a
program that is subject to the provisions of Executive Order 12372
concerning intergovernmental review of Federal programs by appropriate
health planning agencies 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. Applicants (other than Federally-recognized
Indian tribal governments) should contact their State Single Point of
Contact (SPOCs), a list of which will be included in the application
kit, 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 then one State, the applicant is advised
to contact the SPOC of each affected State. All SPOC recommendations
should be submitted to Opal McCarthy, Office of Grants Management,
Bureau of Primary Health Care, East West Building, 11th floor, 4350
East West Highway, Rockville, Maryland 20857, (301) 594-4260. The due
date for State process recommendations is 60 days after the application
deadline for new and competing awards. The granting agency does not
guarantee to ``accommodate or explain'' for State process
recommendations it receives after that date. (See part 148,
Intergovernmental Review of PHS Programs under Executive Order 12372
and 45 CFR part 100 for a description of the review process and
requirements.
OMB Catalog of Federal Domestic Assistance number is 93.211.
Dated: January 18, 1994.
William A. Robinson,
Acting Administrator.
Appendix I
* Census tract numbers are shown below each county name.
State
County
Tract Number
Alabama
Baldwin
0101
0102
0106
0110
0114
0115
0116
Mobile
0059
0062
0066
0072.02
Tuscaloosa
0107
Arizona
Maricopa
0101
0405.02
0507
0611
0822.02
5228
7233
Pima
0044.05
0048
0049
California
Butte
0024
0025
0026
0027
0028
0029
0030
0031
0032
0033
0034
0035
0036
El Dorado
0301.01
0301.02
0302
0303
0304.01
0304.02
0305.01
0305.02
0305.03
0306
0310
0311
0312
0313
0314
0315
Fresno
0040
0063
0064.01
0064.03
0065
0066
0067
0068
0071
0072
0073
0074
0077
0078
0079
0080
0081
0082
0083
0084.01
0084.02
Kern
0033.01
0033.02
0034
0035
0036
0037
0040
0041
0042
0043
0044
0045
0046
0047
0048
0049
0050
0051.01
0052
0053
0054
0055.01
0055.02
0056
0057
0058
0059
0060
0061
0063
Los Angeles
5990
5991
9001
9002
9004
9012.02
9100
9101
9108.02
9109
9110
9200.01
9201
9202
9203.03
9301
Monterey
0109
0112
0113
0114.01
0114.02
0115
Placer
0201.01
0201.02
0202
0203
0204
0216
0217
0219
0220
Riverside
0421
0427.02
0427.03
0429
0430
0431
0432
0444
0452.02
0453
0454
0455
0456.01
0456.02
0457.01
0457.02
0458
0459
0460
0461
0462
San Bernardino
0089.01
0089.02
0090.01
0090.02
0091.01
0091.02
0093
0094
0095
0096.01
0096.02
0096.03
0097.01
0097.03
0097.04
0098
0099
0100.01
0100.02
0102.01
0102.02
0103
0104.01
0104.02
0104.03
0105
0106
0107
San Diego
0189.01
0189.02
0190
0191.01
0208
0209.01
0209.02
0210
0212.01
0212.02
0213
San Joaquin
0040
0044
0045
0052.01
0052.02
0053.02
0053.03
0053.04
0054
0055
Santa Barbara
0018
0019.03
Santa Clara
5117.04
5118
5125.01
5127
Shasta
0126
0127
1504
Sonoma
1506.04
1537.01
1541
1542
1543
Stanislaus
0001
0002.01
0032
0033
0034
0035
0036.05
0037
0038
0039.01
0039.02
Tulare
0002
0003
0004
0005
0006
0007
0026
0028
0040
0043
0044
Ventura
0001
0002
0046
0075.01
Colorado
Adams
0084
0085.13
0087.01
El Paso
0038
0039.01
0046
Larimer
0014
0017.02
0019.02
0020.01
0022
Pueblo
0028.04
0032
0034
Weld
0019.02
0020
0024
0025.01
0025.02
Florida
Collier
0111
0112
0113
0114
Dade
0115
Marion
0002
0004
0005
0027
Osceola
0401.01
0401.02
0402.01
0402.02
0403.01
0403.02
0404
0405.01
0405.02
0405.03
0405.05
0406
Palm Beach
0079.01
0079.02
0080.01
0080.02
0081.01
0081.02
0082.01
0082.02
0082.03
0083.01
0083.02
Polk
0125
0126
0127
0142
0143
0144
0152
0154
0155
0156
0157
0158
0159
0160
0161
Kansas
Butler
0201
0203
0204
0205
0209
Louisiana
Rapides
0106
0135
0136
Terrebonne
0122
0123
Minnesota
St. Louis
0105
0112
0113
0114
0121
0122
0123
0124
0125
0126
0127
0128
0129
0130
0131
0132
0133
0134
0135
0137.01
0137.02
0138
0139
0141
0151
0152
0153
0154
0155
Stearns
0103
0105
0106
0107
0108
0109
0110
0111
Montana
Cascade
0105
Yellowstone
0015
0016
0019
Nevada
Clark
0057
0058
0059
Washoe
0031.04
0032
0033.01
0033.02
0033.03
0033.04
0034
New Mexico
Dona Ana
0014
0019
Santa Fe
0101
0102
0103.01
New York
Herkimer
0101
0105.02
0107
0108
0109
0110.01
0110.02
0111
0112
0113.01
North Dakota
Burleigh
0114
0115
Grand Forks
0114
0115
0116
0118
Morton
0205
Oklahoma
Osage
0103
0104
0105
0106
0107
0108
Oregon
Clackamas
0235
0236
0239
0240
0241
0243
Jackson
0024
0027
Lane
0001
0005
0007.01
0007.02
0008
0013
0014
0015
0016
Pennsylvania
Lycoming
0101
0102
South Dakota
Pennington
0116
0117
Texas
Bexar
1720
1821
1916
Brazoria
0606
0609
0610
0611
0612
0613
0614
0615
0616
0617
0618
0619
0620.01
0620.02
0621
0622
0623
0624
0625.01
0625.02
0625.03
0626.01
0626.02
0627
0628
0629
0630
0631
0632
Harris
0354
0544
0546
Hidalgo
0223
0224
0225
0226
0227
0228
0230
0231
0243
Washington
Benton
0116
0117
0118
0119
0120
Franklin
0208
King
0327
0328
0330
0331
Snohomish
0532
0536
0537
0538
Spokane
0101
0102
0103.01
0103.02
0133
0138
0143
Whatcom
0110
Yakima
0018
0019
0020
0021
0022
0023
0024
0025
0026
Wisconsin
Douglas
0303
Marathon
0017
0018
0020
0021
0022
0023
Wyoming
Laramie
0016
0017
0018
Appendix II
Bureau of the Census Regional Information Service
Atlanta, GA--404-730-3957
Alabama, Florida, Georgia
Boston, MA--617-565-7078
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
Vermont, Upstate New York
Charlotte, NC--704-344-6144
Kentucky, North Carolina, South Carolina, Tennessee, Virginia
Chicago, IL--708-409-4617
Illinois, Indiana, Wisconsin
Dallas, TX--214-767-7105
Louisiana, Mississippi, Texas
Denver, CO--303-969-7750
Arizona, Colorado, Nebraska, New Mexico, North Dakota, South
Dakota, Utah, Wyoming
Detroit, MI--313-354-4654
Michigan, Ohio, West Virginia
Kansas City, KS--913-236-3711
Arkansas, Iowa, Kansas, Missouri, New Mexico, Oklahoma
Los Angeles, CA--818-904-6339
California
New York, NY--212-264-4730
Brooklyn, Bronx, Manhattan, Queens, Staten Island, Nassau Co.,
Orange Co., Suffolk Co., Rockland Co., Westchester Co.
Philadelphia, PA--215-597-8313
Delaware, District of Columbia, Maryland, New Jersey,
Pennsylvania
Seattle, WA--206-728-5314
Idaho, Montana, Nevada, Oregon, Washington
[FR Doc. 94-6283 Filed 3-17-94; 8:45 am]
BILLING CODE 4160-15-P
