[Federal Register Volume 59, Number 79 (Monday, April 25, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-9865]
[[Page Unknown]]
[Federal Register: April 25, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement No. 418]
RIN 0905-ZA05
Project Grants--Health Programs for Refugees; Availability of
Funds for Fiscal Year 1994
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1994 funds for a grant program for
refugees. The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of ``Healthy People
2000,'' a PHS-led national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is related to the
priority area of Immunization and Infectious Diseases. (For ordering a
copy of ``Healthy People 2000,'' see the section ``Where To Obtain
Additional Information''.)
Authority
This program is authorized by section 412(b)(5) of the
Immigration and Nationality Act [8 U.S.C. 1522(b)(5)], as amended.
Smoke-Free Workplace
The PHS strongly encourages all grant recipients to provide a
smoke-free workplace and promote the non-use of all tobacco products.
This is consistent with the PHS mission to protect and advance the
physical and mental health of the American people.
Eligible Applicants
Eligible applicants for this program are the official State health
agencies and current official public health agencies of political
subdivisions who are recipients of Health Program for Refugees project
grant program (New York City; Philadelphia, PA; Barren River District,
KY; Missoula City, MT; Maricopa County, AZ; North Central District,
ID).
National Program Goals
The National Program Goals are:
A. As a high priority, to prevent and control health problems of
public health significance among refugees;
B. As a lesser priority incidental to the provision of services
under A., to improve the general health status of the refugee
population through health assessment and referral, emphasizing those
health problems that may impede effective resettlement and prevent
economic self-sufficiency.
Availability of Funds
Approximately $2,700,000 is expected to be available in FY 1994 to
fund all approved competing grants. It is expected that the average
award will be $56,000, ranging from $5,000 to $900,000, beginning on or
about July 1, 1994, for a 12-month budget period within a 5-year
project period. Funding estimates may change. There is no statutory
cost participation formula.
In agreement with the Office of Refugee Resettlement, CDC will
distribute available funds on an 80% formula and 20% discretionary
basis. (Applicants will continue to submit budgets as in previous
years, i.e., line item detail with a ``Grand Total'' amount of funding
requested.) CDC will distribute 80% of the available funds (e.g.,
$2,160,000 of the $2,700,000) to grantees based on a formula using each
State's proportion of refugee arrivals during the past two years
(including a floor amount of $5,000 for States with a small number of
refugee arrivals). All applicants with approved applications will
receive formula funding. The remaining 20% of available funding (e.g.,
$540,000 of the $2,700,000) will be awarded on a discretionary basis.
Use of Grant Funds
Grant funds may be used for costs associated with planning,
organizing, implementing, and evaluating public health and health
assessment activities directed to refugees, in accordance with 45 CFR
parts 74 and 92. Grant funds may not be used for construction costs or
inpatient care.
Except in special situations that are explained and justified,
grant funds will not be available for direct curative or rehabilitative
services. This restriction applies to subsequent diagnostic or
treatment services provided directly to individual refugees for whom
specific health problems have been identified. It is expected that
other sources of support will generally be identified for these
purposes. Exceptions will be considered for diagnostic and treatment
services that are integral to the conduct of public health programs and
are otherwise not available. However, tuberculosis preventive therapy
outreach activities that are associated with locating refugees for
diagnosis and the provision of treatment are permitted.
If grant funds are used to support bilingual outreach staff,
applicants should ensure appropriate language and culture
compatibility. Applicants are encouraged to use contractual or similar
mechanisms that will allow for maximum flexibility in making personnel
changes due to changing language needs.
Purpose
The purpose of this program is to augment State and local resources
and to assist States and localities in providing health assessments and
follow-up activities to refugees for problems of public health concern.
Health assessments of refugees are intended to identify and lead to the
treatment of health conditions that could affect the public health or
the personal well-being of refugees and impede their effective
resettlement. Communities with the largest refugee populations will be
principally targeted for assistance under this program.
The term ``refugee'' is defined in section 101(a)(42) of the
Immigration and Nationality Act [8 U.S.C. 1101(a)(42)].
These grants are made available in recognition of:
A. The severe strain on public resources in high impact areas
represented by the influx of refugees.
B. Gaps in meeting the health needs of refugees through other forms
of Federal assistance.
C. The need for State level coordination of public health programs,
general health assessments, and referrals for medical, mental, dental,
rehabilitative, and social services.
D. The need to intensify and maintain outreach efforts to improve
upon the number of refugees starting and completing tuberculosis
preventive therapy.
Program Requirements
In conducting the activities to achieve the purpose of the program,
the Grantees must meet the following requirements:
A. Identification
Develop and implement a system to identify all officially arriving
refugees. Use notification forms received from CDC port of entry
quarantine stations to determine primary refugee arrivals. Include a
mechanism to identify secondary refugee arrivals and give priority to
recent arrivals in the United States who have not received an initial
health assessment in their area of previous residence.
B. Contacting Refugees
Contact identified officially arriving refugees shortly after
arrival and offer a health assessment. Carefully explain the importance
of receiving a health assessment and where and how to get to a
convenient health care provider, whenever possible, in the language
spoken by the refugee. Efforts to contact the refugees should include:
1. Close coordination with voluntary agencies (VOLAGS) and other
service agencies.
2. Assisting the refugee to overcome any special barriers to
receiving the health assessment, e.g., lack of transportation.
C. Health Assessment
Provide or coordinate the provision of a health assessment to
officially arriving refugees and identified secondary migrants who have
not previously received a health assessment. Give priority to refugees
with Class A and Class B medical conditions. Although it is expected
that a standard protocol and recommended priorities for health
assessments will be published at a later date, applicants may include
the following components in the health assessment:
1. Screening for tuberculosis, including a tuberculosis skin test
and a chest X-ray if a recent one is not available;
2. Public health history and review of current problems, including
immunization needs;
3. Screening of pregnant women for hepatitis B;
4. Testing for intestinal parasites;
5. Testing for anemia;
6. Complete physical examination including:
a. Oral inspection for dental problems;
b. Height and weight measurement to assess pediatric nutritional
status;
c. Vision and hearing testing; and,
d. Test for hypertension.
D. Referrals for Health Problems
Refer refugees with health problems identified during the health
assessment to the appropriate health care provider for treatment.
Establish a system for follow-up, based on the priority of the
condition identified, to ensure appointments are kept.
E. Health Education
In order for the refugees to be successfully assimilated into the
public health care system, the importance of preventive health should
be taught as part of the health assessment process. Refugees should be
informed, in their own language, about the tests they are receiving and
what the results of the tests mean. The need for obtaining additional
care, testing, and treatment for an identified health problem should
also be carefully explained. Culturally competent and linguistically
appropriate educational pamphlets, slides, or videos, and individual or
group education sessions may be used to provide this information. The
applicant may also provide or coordinate the provision of culturally
sensitive training for staff working with refugees.
F. Coordination with Other Agencies/Organizations
To promote the national goals and use all existing resources to
this end, place special emphasis on coordinating efforts with:
1. Voluntary agencies (VOLAGS);
2. Mutual assistance agencies (MAA);
3. State Department of Social Services;
4. State Advisory Council on Refugee Affairs;
5. Other State and Federally funded programs, such as Medicaid, and
health department immunization and tuberculosis control programs;
6. Private providers of health care to refugees.
Evaluation Conditions and Criteria
A. Formula Conditions
Eligible applicants meeting the following conditions will receive
an award based on the formula described in the ``Availability of
Funds'' section.
1. Has the applicant provided a budget justification and plan of
operation and evaluation?
2. Does the application document the size of the refugee
population, including secondary migrants?
3. Are the proposed objectives specific, measurable, realistic,
time-phased, and related to the National Program Goals?
4. Does the application document coordination with the State
Refugee Resettlement Coordinator?
B. Discretionary Award Evaluation Criteria
Applications will be reviewed and evaluated according to the
following criteria, each carrying equal weight of 25 points:
1. Does the application document the need for support, including:
a. The extent and distribution of unique refugee health problems;
b. The extent and distribution of general refugee health problems;
c. The relationship of the project to existing services?
2. Does the application include a plan for conducting project
activities described in the program description that is consistent with
the State Refugee Resettlement Plan and that will integrate refugees
into existing health services?
3. Does the application include reasonable and appropriate methods
for evaluating the project's effectiveness?
In addition, in determining discretionary award amounts, CDC will
consider the applicant's proposed use of project funds, program
potential, other funding resources, past performance and funding, the
quality of the data collection system, appropriateness and
reasonableness of the budget request, and plans to provide tuberculosis
preventive therapy and outreach services.
Other Reviews
The State Refugee Resettlement Coordinator should have an
opportunity to review and comment on the application prior to its
submission.
Other Requirements
Human Subjects
If the proposed project involves research on human subjects, the
applicant must comply with the Department of Health and Human Services
Regulations (45 CFR part 46) regarding the protection of human
subjects. Assurance must be provided to demonstrate that the project
will be subject to initial and continuing review by an appropriate
institutional review committee. The applicant will be responsible for
providing assurance in accordance with the appropriate guidelines and
form provided in the application kit.
Executive Order 12372 Review
Applications are subject to Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. Applicants should contact their State Single
Point of Contact (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 for each affected State. A
current list of SPOCs is included in the application kit. If SPOCs have
any State process recommendations on applications submitted to CDC,
they should send them to Elizabeth M. Taylor, Grants Management
Officer, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road NE., Mailstop E-16, Atlanta, GA 30305, no later than 60 days after
the application deadline. The Program Announcement Number and Program
Title should be referenced on the document. The granting agency does
not guarantee to ``accommodate or explain'' State process
recommendations it receives after that date.
Public Health System Reporting Requirements
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance Number is 93.987, Health
Programs for Refugees.
Application Submission and Deadline
The program announcement and application kit were sent to all
eligible applicants in February 1994.
Where To Obtain Additional Information
Business management technical assistance including information on
application procedures and copies of application forms may be obtained
from Bernice A. Moore, Grants Management Specialist, Grants Management
Branch, Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., Mailstop E16,
Atlanta, GA 30305, telephone (404) 842-6802. Announcement No. 418,
``Project Grants--Health Programs for Refugees,'' must be referenced in
all requests for information pertaining to this project.
Programmatic technical assistance may be obtained from Richard D.
Moyer, Chief, Medical Screening and Health Assessment Branch, Health
Programs for Refugees, Division of Quarantine, Center for Prevention
Services, Centers for Disease Control and Prevention (CDC), Mailstop
EO3, Atlanta, GA 30333, telephone (404) 639-8110.
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) referenced in the ``Introduction'' may be obtained through the
Superintendent of Documents, Government Printing Office, Washington, DC
20402-9325, telephone (202) 783-3238.
Dated: April 18, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 94-9865 Filed 4-22-94; 8:45 am]
BILLING CODE 4163-18-P
