[Federal Register Volume 59, Number 89 (Tuesday, May 10, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11143]
[[Page Unknown]]
[Federal Register: May 10, 1994]
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Department of Health and Human Services
Health Resources and Services Administration
[PN 2217]
RIN 0905-ZA43
Availability of Funds for Grants for School Health Services and
Health Education/Promotion for Homeless and At-Risk Children and Youth,
and for School Health Staff Development
Agency: Health Resources and Services Administration, PHS.
Action: Notice of availability of funds.
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SUMMARY: The Health Resources and Services Administration (HRSA)
announces the availability of approximately $5.75 million under the
appropriation for fiscal year (FY) 1994, for HRSA's new school health
initiative: the Healthy Schools, Healthy Communities Initiative. The
Bureau of Primary Health Care (BPHC) and the Maternal and Child Health
Bureau (MCHB) will jointly manage this initiative within HRSA.
Under this initiative, approximately $3.25 million is available for
discretionary grants to provide school-based primary health care
services to homeless and at-risk children and youth. This money was
appropriated under Public Law 103-112, the FY 1994 Labor/HHS
Appropriations Act, and is included as part of the funding for the
Outreach and Primary Health Services for Homeless Children Program. The
grants will be awarded under section 340(s) of the Public Health
Service (PHS) Act, 42 U.S.C. 256.
The remainder of the funding for the initiative, approximately $2.5
million, is available through MCHB's Special Projects of Regional and
National Significance (SPRANS) as authorized under section 501(a)(2) of
the Social Security Act, 42 U.S.C. 701(a)(2). One million dollars of
the SPRANS money is for health education/promotion services provided to
homeless and at-risk children and youth through school-based health
centers. The remaining $1.5 million is available for school health
staff development grants.
The $5.75 million for the Healthy Schools, Healthy Communities
Initiative will be awarded through two grant programs. First, $4.25
million is available for grants to provide school-based primary health
care services and health education/promotion for homeless and at-risk
children and youth. Second, $1.5 million is available for grants for
school health staff development.
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. The Healthy Schools, Healthy
Communities Initiative will contribute to meeting the objectives cited
for children and youth, particularly children and youth who are
homeless, at-risk, in low-income families, and/or minorities. In
addition, the initiative will contribute to meeting three of the six
National Education Goals included in the Goals 2000: Educate America
Act. The initiative will address Goal 1 which states: by the year 2000,
all children in America will start school ready to learn; Goal 2 which
states: by the year 2000, the high school graduation rate will increase
to at least 90 percent, and Goal 6 which states: by the year 2000,
every school in America will be free of drugs and violence and will
offer a disciplined environment conducive to learning. In addition,
this program is consistent with many of the elements of the proposed
Health Security Act, particularly Title III, Subtitle G. Potential
applicants may obtain a copy of Healthy People 2000 (Full Report--Stock
No. 017-001-00474-0 or Summary Report--Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC. 20402-9325 (telephone 202-783-3238).
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.
DUE DATES: To receive consideration, applications for the health
services/health education grant and the staff development grant are due
July 15, 1994. Applications are considered as having met the deadline
if they are: (1) Received on or before the established deadline date;
or (2) sent on or before the established deadline date and received in
time for orderly processing. Applicants should obtain a legibly dated
receipt from a commercial carrier or the U.S. Postal Service or obtain
a legibly dated U.S. Postal Service postmark. Private metered postmarks
will not be accepted as proof of timely mailing. Late applications will
not be considered for funding and will be returned to the applicant.
ADDRESSES FOR HEALTH SERVICES/EDUCATION GRANTS: Application kits and
additional guidance (Form PHS 5161-1 with revised face sheet DHHS form
424, as approved by the OMB under control number 0937-0189) for the
health services/health education grants may be obtained from, and
completed applications should be mailed to: Alice H. Thomas, Grants
Management Officer (GMO), Bureau of Primary Health Care, Health
Resources and Services Administration, 4350 East-West Highway,
Bethesda, Maryland, 20814. The telephone number is (301) 594-4260 and
the fax number is (301) 594-4073. Application kits will be distributed
up to two weeks before the application due date. The Grants Management
staff is available to provide assistance on business management issues.
ADDRESSES FOR STAFF DEVELOPMENT GRANTS: Application kits and additional
guidance (Form PHS 5161-1 with revised face sheet DHHS form 424, as
approved by the OMB under control number 0937-0189) for the staff
development grants may be obtained from, and completed applications
should be mailed to: John Gallicchio, Grants Management Officer,
Maternal and Child Health Bureau, Health Resources and Services
Administration, Parklawn Building, Room 18-12, 5600 Fishers Lane,
Rockville, Maryland, 20857. The telephone number is (301) 443-1440 and
the fax number is (301) 443-6686. Application materials will be
available after April 1, 1994.
FOR FURTHER INFORMATION CONTACT: For general program information and
technical assistance, contact Jane Martin, Program Director, School
Health Program, Perinatal and Child Health Branch, Division of Programs
for Special Populations, Bureau of Primary Health Care, 4350 East-West
Highway, Bethesda, Maryland 20814, (301) 594-4470, fax (301) 594-4989,
or contact Linda Johnston, Co-Director, School Health Initiative,
Adolescent Health Branch, Division of Maternal, Infant and Child
Health, Maternal and Child Health Bureau, Parklawn Building, room 18A-
39, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 443-4026, fax
(301) 443-1296.
SUPPLEMENTAl INFORMATION
School-Based Health Services and Health Education/Promotion Grants
for Homeless and At-Risk Children and Youth
Grant Amounts: Approximately $4.25 million is available for grants
to provide school-based health services and health education/promotion
to homeless and at-risk children and youth. Of the $4.25 million, $3.25
million is for primary and preventive health care services; $1.0
million is for health education/promotion purposes. Each grantee will
only receive one grant award that will include funds for both health
services and health education/promotion.
Number of Awards: Approximately 15-20 awards will be made, with a
total possible maximum of $285,000 for each grant. Awards will range
from $100,000 to $220,000 for school-based health services and from
$40,000 to $65,000 for school health education/promotion. Awards will
be made for a one-year budget period and a three-year project period.
Match Requirements: Only grantees that are hospitals are required
to contribute (directly or through donations from public or private
entities) not less than $1 in non-Federal contributions for each $1 of
Federal funds provided in the health services portion of the grant.
Non-Federal contributions may be in cash or in-kind, fairly evaluated,
including plant, equipment, or other services. Amounts provided by the
Federal Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not be included in
determining the amount of such non-Federal contributions. It is
important to note that this match does not apply to the health
education/promotion portion of the grant.
Eligible Applicants: An eligible applicant is a community-based
primary health care provider. Eligible health care providers are
community-based public or nonprofit private entities that have a
history of providing primary health services to a substantial number of
homeless, at-risk, or medically underserved children and youth in the
community, e.g., health care for the homeless centers, community and
migrant health centers, local health departments, public housing
primary care centers, and children's hospitals.
The provider must have established a partnership with a school or
school district, but only the health care provider is the applicant.
Together the health provider and school must have established a
cooperative arrangement with at least one community organization that
will supplement, expand, and enrich the services provided through the
school-based health center. Applicants are encouraged to establish as
many cooperative arrangements as are desirable and feasible (e.g., with
Health Care for the Homeless projects, homeless shelters, soup
kitchens, other community organizations that serve the homeless,
community mental health centers, social service agencies, local youth
organizations, and community service organizations).
Grantees must have an agreement with a State under its Medicaid
program, title XIX of the Social Security Act (if they provide services
that are covered under the title XIX plan for the State), and be
qualified to receive payments under the agreement. This requirement may
be waived if the organization does not, in providing health care
services, impose a charge or accept reimbursement available from any
third-party payor, including reimbursement under any insurance policy
or under any Federal or State health benefits program. It is expected
that grantees will maximize third party reimbursement to which they are
entitled, including Medicaid.
Grants will be made for a variety of arrangements, including
programs in rural and urban areas. Grants will be awarded for programs
in elementary schools, middle schools or junior high schools, high
schools, or a combination of schools. Funds are not available to
enhance existing school-based health centers. The funds are intended to
be used to establish new school-based health centers that offer
comprehensive primary care services. An applicant that currently
operates a school-based health center may use these funds to establish
a new center in another school.
Other Requirements: Restrictions on the use of grant funds are as
follows: (1) Grant funds may not be used to pay for inpatient services,
except for residential treatment for substance abuse provided in
settings other than hospitals; (2) grant funds may not be used to make
cash payments to intended recipients of primary health, substance abuse
or mental health services; and (3) grant funds may not be used to
purchase major medical equipment or to purchase or improve real
property (other than minor remodeling of existing improvements to real
property, which is allowable for rebudgeting without prior approval for
amounts up to a cumulative maximum of $25,000). The Secretary may waive
this restriction upon request by an applicant demonstrating that the
purposes of the project cannot otherwise be carried out.
The grantee must, directly or through contract, provide services
without regard to ability to pay for the services. If a charge is
imposed for the delivery of services, such charge: (1) Will be made
according to a schedule of charges that is made available to the
public; (2) will not be imposed on any individual with an income less
than the official poverty level (the nonfarm income official poverty
line defined by the Office of Management and Budget); and (3) will be
adjusted to reflect the income and resources of the individual
involved.
Program Services: Grants will be awarded to school-based health
center programs that will offer comprehensive primary care and health
education/promotion services including, but not limited to: (1)
Outreach and other access-related services including care coordination/
case management, translation, and transportation, as needed; (2)
diagnosis and treatment of acute and chronic conditions; (3) laboratory
services necessary to diagnose and treat acute and chronic conditions
(these may be provided directly, through contract arrangements, or
through formal referrals); (4) preventive health services, including
health screenings and immunizations; (5) mental health and counseling
services, and necessary referrals for child abuse prevention and
treatment, specialized mental health services, social services, and
substance abuse treatment; (6) preventive dental services (these may be
provided directly, through contract arrangements, or through formal
referrals); (7) a school health education/promotion program; and (8)
arrangements for coverage during non-school hours. The health
education/promotion activities should build on and be integrated with
existing health education/promotion activities and should address the
unmet needs of students.
Target Populations: This program is designed to serve children in
kindergarten through the twelfth grade who are homeless or at imminent
risk of homelessness, including children in unstable housing situations
or who have incomes or family incomes below 200% of the federal poverty
level (the nonfarm income official poverty line defined by the Office
of Management and Budget).
While the school-based health center will target services to those
children described above, the school-based health center must serve all
students in the school who wish to enroll in the center.
Data and Management Information System (MIS) Requirements: The
funding agencies will provide the software to be used for the
acquisition of data needed for program monitoring and the national
evaluation. Purchase of appropriate hardware to run the software will
be an allowable expense under the grant. The system to be employed will
meet very specific requirements to be further articulated in the
program guidance. Broad data categories include, but are not limited
to, demographics, insurance status, diagnoses, services provided,
referrals, and follow-up. The data requirements for the national
evaluation are subject to OMB approval and will not be implemented
until approval is obtained.
Criteria for Evaluation: Applicants will be evaluated on their plan
for health services and health education/promotion based upon the
following criteria:
Need: Degree of need for school-based health services,
which must include but not be limited to the following indicators: (1)
Estimate of the number of homeless children and children at imminent
risk of homelessness in the school and community, with estimation
method specified; (2) level of poverty in school and community,
including school receipt of Chapter 1 funds, and in particular, school
designation as a Chapter 1 school-wide program; (3) the number of
children who are eligible for free or reduced price lunches; (4) degree
to which the population in the community is medically underserved; (5)
presence of significant barriers to health care for students in the
community (e.g., lack of transportation, language); and (6) indicators
of health risks for school-aged children and youth such as intentional
and unintentional injuries, violence, alcohol and other drug abuse,
sexually transmitted disease, adolescent pregnancy, juvenile justice
involvement, and high proportion of children with special health care
needs;
Proposed Plan and Project Description: The extent to which
the applicant has: (1) Demonstrated its capability to successfully
implement and administer the proposed plan; (2) specified appropriate
and measurable goals and objectives that address the needs of the
target population identified through a completed community needs
assessment; (3) demonstrated the feasibility of implementing the
program based on the time frame proposed; (4) described an appropriate
multidisciplinary team of health professionals who will deliver
services; (5) provided for an arrangement between the health care
provider and the school that specifies how referrals and off site
treatment will be handled and, where appropriate, specified the role of
the school nurse, school psychologist, and other school personnel in
the staffing of the clinic and the provision of health services to
students; (6) outlined a suitable quality assurance program for
services provided under the grant; (7) specified administrative
procedures for fiscal control and fund accounting procedures which
provide for reasonable financial administration of Federal and non-
Federal funds; (8) specified plans for and evidence of financial
ability to continue program beyond project period; (9) included health
education/promotion activities that will adequately address unmet
health education needs of students; (10) integrated health education/
promotion services with new and existing school health services, health
education/promotion programs, and other education programs, if any,
(e.g., counseling, special education, services provided by a school
nurse, including those provided under IDEA, and activities funded under
the Drug Free Schools and Communities Act); and (11) specified health
education/promotion activities that complement the existing health
education curriculum (the activity should target those health
education/promotion needs which are identified as top priority based
upon the needs assessment);
Project Collaboration, Coordination and Community Support:
(1) The extent to which the health provider and school have established
cooperative arrangements with community groups that will supplement,
expand, and enrich the services provided through the school-based
health center; (2) the degree to which the applicant has and will
continue to work with other Federal, State and local programs
(particularly State health agencies and their Primary Care Cooperative
Agreement staff and the Maternal and Child Health (Title V) staff,
local schools, mental health service agencies, substance abuse service
agencies, and Medicaid); (3) the extent of community support,
particularly among families, caregivers and the students themselves;
(4) the extent of support from school personnel and organizations
(e.g., principal, school board, school nurses, PTA, Student Council);
and (5) evidence of willingness of collaborating and/or supporting
organizations to contribute resources, both cash and in kind, for the
school-based health center program;
Budget: Adequacy and appropriateness of the proposed
budget (i.e., detailed projections of revenue and costs in accordance
with grant application instructions), including the health education/
promotion budget subsection;
Outcome and Evaluation: (1) The strength of the self-
evaluation plan to monitor the progress of the program and to assess
and document outcomes of the program; and (2) evidence of applicant's
commitment to participate in a national evaluation and use the software
provided by the funding agency.
SUPPLEMENTAL INFORMATION
School Health Staff Development Grants
Background: The purpose of these grants is to build capacity at the
State and local levels, consistent with the goals of the proposed
Health Security Act, in order to provide staff development for local
education agency and local health agency personnel involved in school-
based health centers or in school-linked programs. Proposed programs
could include training for the following types of staff: health care
providers, allied health professionals, and health educators. Emphasis
should be placed on training to work with a multidisciplinary team.
Grant Amounts and Number of Awards: There will be approximately
$1.5 million available for up to 10 school health staff development
grants for Fiscal Year 1994, to enhance the operation of school-related
health services. Awards will be made for a one-year budget and project
period.
Eligible Applicants: Eligible applicants are State health agencies
or public and private nonprofit institutions of higher learning. The
applicant must demonstrate full partnership between the State health
agency and the institution of higher learning and, as appropriate,
other community organizations and/or professional associations.
Criteria for Evaluation: Grantees will be evaluated based upon the
following criteria:
Need: Degree of need for school health program staff
development as identified in a needs assessment;
Proposed Plan: The extent to which the proposed plan has:
(1) Specified appropriate goals and objectives (e.g., specify knowledge
expected to be learned to upgrade skills and competencies to work in
school health settings); (2) provided a description of proposed program
to provide staff development for individuals who work in school health
settings; (3) utilized existing staff development programs, where
appropriate (e.g., the Interdisciplinary Adolescent Health Project(s)
and the Center for Continuing Education in Adolescent Health supported
by funds from MCHB); and (4) demonstrated the soundness of the
project's proposed management, as assessed by the qualifications of the
staff of the proposed project, the applicant's facilities and
resources, and the capability to fulfill the proposed goals and
objectives to meet staff development needs;
Budget: Adequacy and appropriateness of proposed budget;
Outcome and Evaluation: (1) The adequacy of the plan to
monitor the progress of the program and to assess and document outcomes
of the program; and (2) evidence of commitment to participate in a
national evaluation.
Other Award Information
The programs under the Healthy Schools, Healthy Communities
Initiative are 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 point of contact (SPOC) in the State for the
review. Applicants (other than federally-recognized Indian tribal
governments) 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.)
These programs are subject to the Public Health System Reporting
Requirements approved by the Office of Management and Budget (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 nongovernmental applicants are required to submit
certain information to the head of the appropriate State and local
health agencies in the area(s) to be impacted. This information should
be submitted no later than the Federal application receipt due date.
The information includes:
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 and local health agencies.
The OMB Catalog of Federal Domestic Assistance numbers for the HRSA
Healthy Schools, Healthy Community Initiative are 93.151 and 93.110.
Dated: March 18, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-11143 Filed 5-9-94; 8:45 am]
BILLING CODE 4160-15-P
