[Federal Register Volume 61, Number 55 (Wednesday, March 20, 1996)]
[Notices]
[Pages 11424-11426]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-6664]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
The Ryan White Comprehensive AIDS Resources Emergency Act of
1990; Availability of Funds for Early Intervention Services
AGENCY: Health Resources and Services Administration, HHS.
ACTION: Availability of Funds for Grants To Provide Outpatient Early
Intervention Services with Respect to HIV Disease.
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SUMMARY: The Health Resources and Services Administration (HRSA)
announces that applications will be accepted for fiscal year (FY) 1996
discretionary grants to provide outpatient early intervention services
including primary care services with respect to human immunodeficiency
virus (HIV) disease.
These grants are awarded under the provisions of subpart II and
subpart III of part C of title XXVI of the Public Health Service (PHS)
Act, as amended by the Ryan White Comprehensive AIDS Resources
Emergency (CARE) Act of 1990, Public Law 101-381 (42 U.S.C. 300ff-51--
300ff-67).
This program announcement is subject to the final action on the
appropriation of funds. At this time, given the continuing resolutions
and the absence of a final FY 1996 appropriation for Ryan White Title
III(b) programs, the specific amount available is not known.
The PHS is committed to achieving the health promotion and disease
prevention objectives of Healthy People 2000, a PHS-led national
activity for setting health priorities. This grant program is related
to the objectives cited for special populations, particularly people
with low income, minorities, and the disabled, which constitute a
significant portion of the homeless population. 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 20402-9325 (telephone 202 783-3238).
PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and 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.
DUE DATES: Applications are due on June 1, 1996. Applications will be
considered to have met the deadline if they are: (1) received on or
before the deadline date; or (2) postmarked on or before the
established deadline date and received in time for orderly processing.
Applicants should request a legibly dated U.S. Postal Service postmark
or obtain a legibly dated receipt from a commercial carrier or U.S.
Postal Service. Private metered postmarks are not acceptable as proof
of timely mailing. Applications received after the announced closing
date will not be considered for funding.
ADDRESSES: Application kits (Form PHS 5161-1) with revised face sheet
DHHS Form 424, as approved by the Office of Management and Budget under
control number 0937-0189 may be obtained from, and completed
applications should be mailed to, Bureau of Primary Health Care (BPHC)
Grants Management Officer (GMO), c/o Houston Associates, Inc., 1010
Wayne Avenue, Suite 1200, Silver Spring, MD 20901 (telephone 1-800-523-
2192; FAX 301-523-2193). The Office of Grants Management can provide
assistance on business management issues. The BPHC Office of Grants
Management is located at 4350 East West Highway, Bethesda, MD 20814
(telephone 301-594-4235).
FOR FURTHER INFORMATION CONTACT: For general program information and
technical assistance, contact Joan Holloway, Director, Division of
Programs for Special Populations, Bureau of Primary Health Care (BPHC),
at 4350 East-West Highway, Bethesda, Maryland 20814 (telephone 301-594-
4444).
SUPPLEMENTARY INFORMATION:
Number of Awards
It is anticipated that should sufficient funds become available,
approximately 50 competing grants may be awarded to organizations to
provide early intervention services with respect to HIV. These grants
may range from approximately $100,000 to approximately $500,000 and be
made for a maximum of three years. Continuation awards for any future
years will be made subject to the availability of funds and
satisfactory performance in past budget years toward meeting the goals
and objectives of the project.
Eligible Applicants
Eligible applicants are public entities and nonprofit private
entities that are: migrant health centers under Section 329 of the PHS
Act; community health centers under Section 330 of the PHS Act; health
care for the homeless grantees under Section 340 of the PHS Act; family
planning grantees under Section 1001 of the PHS Act other than States;
comprehensive hemophilia diagnostic and treatment centers; federally-
qualified health centers under section 1905(1)(2)(B) of the Social
Security Act; or public and private nonprofit entities that currently
provide comprehensive primary care services to populations at risk of
HIV disease.
Both existing Title III(b) grantees whose project periods end
September 30, 1996 and new applicants that meet eligibility
requirements may apply.
Project Requirements
Funding under this grant program is intended to increase the
capacity and accessibility of the specified entities to offer a higher
quality and a broader scope of HIV-related early intervention services
to a greater number of people in their service areas with or at risk
for HIV infection. The program must meet the conditions specified in
the statute and provide the services specified in the statute (sections
2651, 2661 and 2662 of the Public Health Service Act). In addition, the
program may provide certain optional services.
The required services to be provided under this grant are:
Comprehensive individual counseling, including counseling
of pregnant women, regarding HIV disease according to specific
statutory mandates for the content and conduct of pretest counseling,
counseling of those with negative test results, counseling of those
with positive results, with attention to the appropriate setting for
all counseling;
Testing individuals with respect to HIV disease, in
laboratories certified by the Clinical Laboratories Improvement
Amendments, including tests to confirm the presence of the disease,
tests to diagnose the extent of the deficiency in the immune system,
and tests to provide information on appropriate therapeutic measures
for preventing and treating the deterioration of the immune system and
[[Page 11425]]
for preventing and treating conditions arising from the disease;
Referral to appropriate providers of health and support
services, including, as appropriate to entities funded under parts A
and B of title XXVI of the PHS Act, to biomedical research facilities,
community-based organizations or other entities that offer experimental
treatment for HIV disease, and to grantees under section 2671 for the
care of pregnant women;
Other clinical and diagnostic services regarding HIV
disease, and periodic medical evaluations of individuals with the
disease; and
Providing therapeutic measures for preventing and treating
the deterioration of the immune system and for preventing and treating
conditions arising from the disease.
Optional services that may be included if they can be shown to be
essential to the delivery of care are:
Outreach, case management, and counseling for eligibility
for other health services.
Applicants, or providers acting under an agreement with the
applicant, must be participating and qualified providers under the
State Medicaid plan approved under title XIX of the Social Security
Act, unless the participation agreement has been waived by the
Secretary. A waiver procedure is available from BPHC. Grantees are
required to maximize service reimbursements from private insurance,
Medicare, other Federal programs, and other third-party payment
sources.
Other Grant Requirements
The applicant must agree that the services provided will conform to
the assurances and agreements required under the statute that:
The applicant will participate in an HIV care consortium
established pursuant to part B, title XXVI, if such a consortium
exists.
Hemophilia services will be provided through the network
of regional comprehensive hemophilia diagnostic and treatment centers.
The applicant will ensure confidentiality of patient
information.
Testing will be provided only after obtaining a statement
that the testing is done after counseling has been conducted and that
the decision of the individual to undergo testing is voluntarily made.
Opportunities for anonymous testing will be provided.
Individuals seeking services will not have to undergo
testing as a condition of receiving other health services.
A sliding fee schedule which conforms to the requirements
at *section 2664(e) of the PHS Act will be utilized.
Funds will not be expended for services covered, or which
could reasonably be expected to be covered, under any State
compensation program, insurance policy, or under any Federal or State
health benefits program, or by an entity that provides health services
on a prepaid basis.
Funds will be expended only for the purposes awarded, and
such procedures for fiscal control and fund-accounting, as may be
necessary, will be established.
Counseling programs shall be designed to reduce exposure
to, and transmission of HIV disease by providing accurate information;
and shall provide information on the health risks of promiscuous sexual
activity and injecting drug use.
No more than 5 percent of the grant funds may be expended
for administrative expenses. Funds may not be expended for
construction, inpatient care, residential care, or cash payments to
recipients of services.
The HIV Client and Program Profile, which has been
formally established as the Minimum Data Set (MDS) for BPHC, will be
submitted annually. (Approved under the Paperwork Reduction Act, OMB
No. 0915-0158.)
A review of applications may take place to screen out new
application(s) which should not be forwarded to the objective review
committee because the above-mentioned requirements have not been met.
Criteria for Evaluating Applications
These competitive applications for grant support will be reviewed
based upon the following evaluation criteria:
The need in the community, based on the 2-year period
preceding the proposed grant period, for additional preventive and
primary care services to those at risk for HIV infection, including
women, children, and minorities, and to persons with HIV infection;
barriers to meeting those needs within the existing service provider
system; and other information (e.g., epidemiological and health
resources data) that makes a compelling case for the grant requested as
specified in section 2653 of the PHS Act.
The extent of the applicant's role within the community in
addressing the unmet needs for delivery of HIV primary care services to
the targeted populations.
The degree to which the proposed budget is appropriate to
the program plan and the degree to which coordination with other
funding sources is documented.
Comprehensiveness of the existing, plus proposed, scope of
counseling and testing, referral, primary care prevention, diagnostic
and treatment services, and optional outreach, case management, or
eligibility assistance services provided by the applicant; and
development of mechanisms to assure continuity of primary care for
persons living with HIV infection.
The applicant's demonstrated efforts related to
implementation of the HRSA Program Advisory, ``ZDV Therapy for Reducing
Perinatal HIV: Implementation in HRSA Funded Programs.''
Extent of active inclusion of people living with HIV
disease in program planning or program implementation or program
evaluation or formal advisory activities.
Evidence of the provision of comprehensive oral health
services (diagnostic, preventive, and therapeutic) as an integral part
of the applicant's HIV early intervention program.
Extent to which actions taken assure effective
collaboration with city/county/State health department HIV prevention
activities supported by the Centers for Disease Control and Prevention,
and with State Care Consortia funded under section 2613 of the PHS Act;
extent to which efforts are consistent with priorities of the HIV
Planning Council in the cities funded under Title XXVI of the PHS Act,
and with programs funded by other PHS agencies.
The adequacy and completeness of the program evaluation
plan, and the relationship of the evaluation plan to the goals and
objectives of the proposed program, so that effectiveness can be
measured.
IN ADDITION, FOR PROJECT PERIOD RENEWALS: The degree to which the
grantee succeeded in accomplishing the goals and objectives in the
preceding project period, including the extent to which HIV primary
care services were integrated into the applicant's overall primary care
program; and a record of compliance with reporting requirements in
effect during that period.
IN ADDITION, FOR NEW APPLICANTS: demonstrated ability of the
applicant organization to carry out the proposed program, including the
extent to which the proposed key clinical staff have had prior
experience in the provision of clinical care for individuals with HIV
infection.
[[Page 11426]]
Planning Grants
In the event that an amendment to the Ryan White CARE Act
authorizing planning grants is enacted before the application due date
of June 1, applications will be accepted for fiscal year (FY) 1996
planning grants to develop a system of care to provide outpatient early
intervention services including primary care services with respect to
human immunodeficiency virus (HIV) disease. Subject to the availability
of funds, it is anticipated that approximately 10 grants ranging from
approximately $25,000 to $50,000 each may be awarded. The awarding of a
planning grant will range from one to three years and will not, in any
way, commit the PHS to support the applicant for additional planning
grants or for future operational funding.
Eligible Applicants for Planning Grants
Applicants for planning grants must be public entities and
nonprofit private entities that are: migrant health centers under
Section 329 of the PHS Act; community health centers under Section 330
of the PHS Act; health care for the homeless grantees under Section 340
of the PHS Act; family planning grantees under Section 1001 of the PHS
Act other than States; comprehensive hemophilia diagnostic and
treatment centers; federally qualified health centers under section
1905(1)(2)(B) of the Social Security Act; or public and private
nonprofit entities that currently provide comprehensive primary care
services to populations at risk of HIV disease. The applicant must be
located in a rural or underserved community where emerging or ongoing
HIV issues have not been adequately addressed.
Project Requirements for Planning Grants
Funding under this grant program is intended to increase the
capacity and accessibility of the specified entities to offer a higher
quality and a broader scope of HIV-related early intervention services
to a greater number of people in their service areas who are at risk of
HIV infection. The program must propose to address the requirements for
the Ryan White Early Intervention Services Program, as outlined above,
and as specified in the statute and provide the services specified in
the statute (sections 2651, 2661 and 2662 of the Public Health Service
Act).\1\
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\1\ These references will be clarified in the program guidance
document.
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Criteria for Evaluating Applications for Planning Grants
These competitive applications for grant support will be reviewed
based upon the following evaluation criteria:
The need in the community, based on the 2-year period
preceding the proposed grant period, for additional preventive and
primary care services to those at risk for HIV infection, including
women, children, and minorities, and to persons with HIV infection;
barriers to meeting those needs within the existing service provider
system; and other information (e.g., epidemiological and health
resources data) that makes a compelling case for the grant requested.
The applicant's proposed role within the community in
addressing the unmet needs for delivery of HIV primary care services to
the targeted populations.
The degree to which the proposed budget is appropriate to
the program plan and the degree to which coordination with other
funding sources is documented.
The degree to which the applicant proposes to include
people living with HIV disease in program planning or program
implementation or program evaluation or formal advisory activities.
The degree to which the applicant proposes effective
collaboration with city/county/State health department HIV prevention
activities supported by the Centers for Disease Control and Prevention,
with State Care Consortia funded under Section 2613 of the PHS Act,
with the HIV Planning Council in the cities funded under Title XXVI of
the PHS Act, and with programs funded by other PHS agencies.
The adequacy and completeness of the program evaluation
plan, and the relationship of the evaluation plan to the goals and
objectives of the proposed program, so that effectiveness can be
measured.
Other Award Information
Public Health System Reporting Requirements: Under these
requirements (approved by the Office of Management and Budget 0937-
0195), 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 nongovernmental 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:
(1) A copy of the face page of the application (SF 424).
(2) A summary of the project, not to exceed one page, which
provides:
(a) A description of the population to be served,
(b) A summary of the services to be provided, and
(c) A description of the coordination planned with the appropriate
State and local health agencies.
The Program to Provide Outpatient Early Intervention Services with
Respect to HIV Disease has been determined to be a program which 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. 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 point of contact (SPOC) in
the State for the review. Applicants (other than federally recognized
Indian tribal governments) should contact their SPOC 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
BPHC does not guarantee that it will accommodate or explain its
responses to State process recommendations received after the date.
(See ``Intergovernmental Review of Federal Programs'', Executive Order
12372, and 45 CFR part 100 for a description of the review process and
requirements.)
The OMB Catalog of Federal Domestic Assistance number for this
program is 93.918.
Dated: March 14, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-6664 Filed 3-19-96; 8:45 am]
BILLING CODE 4160-15-P
