95-11832. Grants and Cooperative Agreements; Availability, etc.: Managed Care Impact on People With Significant Physical and Mental Disabilities

[Federal Register Volume 60, Number 93 (Monday, May 15, 1995)]
[Notices]
[Pages 25921-25926]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-11832]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary


Grants and Cooperative Agreements; Availability, etc.: Managed 
Care Impact on People With Significant Physical and Mental Disabilities

AGENCY: Office of the Assistant Secretary for Planning and Evaluation 
(ASPE), Department of Health and Human Services (HHS).

ACTION: Request for applications to conduct research to better 
understand the impact of managed care on people with significant 
physical and mental disabilities. Projects will analyze existing data 
sets to explore issues of utilization, access, quality, costs and 
outcomes for people with disabilities in managed care systems. In 
addition, where possible proposed applications shall capitalize on 
linking state and local data sets containing data on functioning and 
health status for disabled individuals to utilization and cost data. 
For purposes of applications requested under this announcement, 
``individuals with disabilities'' includes those under the age of 64 
with ongoing conditions or chronic illnesses of such severity that they 
result in a need for extra or specialized health services or assistance 
with daily living tasks. Specific groups of disabled individuals 
included in this definition are children and working aged adults 18-65 
with physical disabilities, mental retardation, developmental 
disabilities and persistent mental illness.

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SUMMARY: The primary goal of this grant announcement is to support 
research which employs the analysis of existing data and experience to 
inform policies related to disability and managed health care. Data 
sets which permit the Department to compare the service use, 
expenditures and outcomes of children and working age adults (18-64) 
with disabilities in managed care with similar persons in the fee-for-
service system or that allow for an assessment of utilization and costs 
prior to and following managed care enrollment are of particular 
interest. Such data sets could include information from: Medicaid 
management information systems; community provider networks including 
community health centers; private insurers and health plans; employers; 
social security records; hospital records and other accessible data 
sets which contain relevant analytical variables. These projects are 
intended to foster new analyses of existing data sources by encouraging 
the use of data sets from states, local areas, or facilities in order 
to address issues of quality, cost, access and outcomes. We estimate 
that the scope and level of effort will require from 12 to 24 months to 
accomplish.

DATES: The closing date for submitting applications under this 
announcement is July 14, 1995.

ADDRESSES: Send application to Grants Officer, Office of the Assistant 
Secretary for Planning and Evaluation, Department of Health and Human 
Services, ASPE/IO, 200 Independence Avenue, SW., Room 405F, Hubert H. 
Humphrey Building, Washington, DC 20201. Attention: Albert A. Cutino, 
Grants Officer.

FOR FURTHER INFORMATION CONTACT:
Application Instructions and Forms should be requested from and 
submitted to: Grants Officer, Department of Health and Human Services, 
ASPE/IO, 200 Independence Avenue, SW., Room 405F, Hubert H. Humphrey 
Building, Washington, DC 20201, Telephone: [phone]. Requests for 
Forms will be accepted and responded to up to 30 days prior to closing 
date of receipt of Applications. Technical questions should be directed 
to Andreas Frank or Kevin Hennessy, ASPE/IO, Telephone [phone] 
or [phone]. Questions also may be faxed to [phone]. 
Written technical questions should be addressed to Dr. Hennessy or Mr. 
Frank at the above address. (Application submissions may not be faxed.)

ELIGIBLE APPLICANTS: The Department seeks applications from 
universities, post-secondary degree granting entities, managed care 
organizations, private employers and insurers, and other independent 
researchers. (For-profit organizations are advised that no grant funds 
may be paid as profit to any recipient of a grant or subgrant.) Profit 
is any amount in excess of allowable direct and indirect costs of the 
grantee.

SUPPLEMENTARY INFORMATION:

Part I

Legislative Authority

    This cooperative agreement is authorized by Section 1110 of the 
Social Security Act (42 U.S.C. 1310) and awards will be made from funds 
appropriated under Public Law 103-112 (DHHS Appropriations Act for FY 
1995).

Project History and Purpose

    Rising health care expenditures have attracted considerable 
attention and concern over the past decade. Of particular concern to 
state and federal governments, Medicaid spending had increased from $41 
billion in 1985 to $138 billion by 1994. In an effort to control 
spiraling Medicaid costs, states are increasingly turning to managed 
care, with estimates that approximately 25% of current Medicaid 
recipients are covered by a form of managed care, although 
participation remains concentrated in a relatively few states. With the 
demise of national health care reform this trend is expected to 
accelerate.
    Over 93% of Medicaid payments are now made on a fee-for-service 
basis. Why is such a small proportion of Medicaid payments affected by 
the movement to managed care? An important reason is that about 70% of 
Medicaid expenditures goes to support the health care of the disabled 
and for long term care--neither of which is included in state managed 
care arrangements to any great extent.
    Although research on the impact of managed care is still relatively 
new, studies of the public sector suggest that costs savings can be 
achieved without significant compromising quality. To beleaguered 
states trying to find ways to tame their Medicaid budget, the desire to 
incorporate their disabled and long term care populations under managed 
care is understandable. [[Page 25922]] 
    In theory, managed care should have significant potential for 
improving services to people with disabilities including: (1) Increased 
flexibility to design treatment programs tailored to their special 
needs; (2) more resources for preventative services and care 
management/coordination; and (3) lower out-of-pocket burdens. However, 
people with disabilities are concerned that overemphasis on cost 
reduction may overshadow the potentially positive benefits of managed 
care. They worry that the financial incentives resulting from a 
capitation system will result in reduced access to needed services, and 
that those providers with specialized expertise in disability may be 
discouraged from participating in managed care arrangements.
    State interest in incorporating disabled persons into Medicaid 
managed care systems--either through 1915(b) or 1115 waiver 
authorities--has grown dramatically in recent years. Currently, Oregon, 
Florida, Tennessee and Arizona have approved 1115 waivers that enroll 
one or more segments of their disabled population into managed care. 
Another 16 states have received freedom of choice waivers (1915b) under 
which they have mandated enrollment of certain segments of the SSI 
disabled population into managed care. However, most of these 1915(b) 
efforts involve primary care cases management (PCCM) rather than 
capitation and the assumption of financial risk.
    The greatest momentum toward managed care remains in the private 
sector. Among employer-based plans, and rapid increase in enrollment in 
managed care plans is well documented. Along with this general trend is 
a series of developments which directly links private sector managed 
care arrangements to populations with special needs e.g., the 
development of subacute care in hospitals and skilled nursing 
facilities; the development of contracts between providers of 
rehabilitation services and employer-based health plans; new forms of 
home health care for high risk populations, carve-outs for managed 
behavioral health services (including alcohol and substance abuse 
services).
    In short, the movement toward managed care in the public and 
private sectors is an important and continuing trend that is likely to 
have a significant impact on people with disabilities. Yet the 
development of a knowledge base that is available to state and federal 
policy makers, insurers and health plans, and consumers to facilitate 
informed decision-making about managed care and disability has barely 
begun. A variety of critical questions demand answers. For example:
     How well does managed care serve people with disabilities 
in comparison to the fee-for-service system?
     What health care and related services do people with 
disabilities need?
     How should quality and effectiveness of care for people 
with disabilities be measured?
     How can financial incentives be created for health plans 
to adequately serve people with disabilities?
     How can capitation payments be developed which reflect the 
service use patterns of disabled populations?
     What are the most effective ways of managing the care of 
special needs populations?
    It is essential that careful attention is directed to adequately 
addressing these and other important questions, especially at a time in 
which federal, state, and private insurers have strong incentives to 
enroll disabled populations into managed care.
    To develop information which evaluates the impact of managed care 
on persons with disabilities and supports the development of approaches 
which efficiently and effectively respond to their needs, the Office of 
the Assistant Secretary for Planning and Evaluation has developed a 
broad-based research plan. This plan includes the following components:
    1. Studies which track the service use, cost and outcomes of non-
elderly SSI recipients enrolled in managed care under state-wide 
Medicaid 1115 health reform demonstrations.
    2. Studies of the experiences of disabled populations enrolled in 
large, privately insured, employer-based managed care plans.
    3. Studies which document the best practices of innovative public 
and private managed care plans that serve people with disabilities.
    4. A program of grants to encourage experts in a variety of 
settings to identify and analyze existing data sets which can inform 
the development of managed care policies and practices which are 
responsive to special needs populations.
    This grant announcement encompasses the fourth component of the 
above research strategy.

Available Funds

    1. The Assistant Secretary has available $800,000 for awards in the 
$50,000 to $150,000 range.
    2. We will consider application over $150,000, but should be 
submitted as a separate additional application(s).
    3. Nothing in this application should be construed as committing 
the Assistant Secretary to dividing available funds among all qualified 
applicants or to make any award. The selection of the final awards will 
be determined by the Assistant Secretary on the basis of the 
availability of funds, the criteria in Part III of this announcement, 
and coverage of the Policy Research Area(s) in Part II of this 
announcement.

Period of Performance

    Award(s) pursuant to this announcement will be made on or about 
September 1, 1995.

Part II. Policy Research Areas

    Research conducted under grants awarded through this announcement 
should be addressed to research questions related to a combination of 
the following topics: (a) defining and measuring disability in health 
care system, (b) analyzing the impact of managed care on access to 
health care services, service use patterns and expenditures, (c) 
assessing the impact of managed care on individual outcomes and other 
quality indicators, (d) financing and reimbursement incentives which 
encourage/impede participation in managed care, and (e) organization of 
the delivery system for disabled populations enrolled in managed care.

A. Definition and Measurement of Disability

    In principle, the movement of both Medicaid programs and large 
employers to managed care delivery systems affords an opportunity to 
study the impact of managed care on large numbers of disabled 
individuals. The difficulty is in determining ways to identify such 
persons so that their experience can be tracked and compared to others 
without disabilities and with similarly disabled persons in the fee-
for-service system. Further complicating this problem is the often 
large variation in service use patterns of people with similar 
disabling conditions.
    The goals of this research area are to encourage exploration of 
alternative approaches to defining and measuring disability and to 
examine the results of these measures in health care settings. ASPE is 
particularly interested in the health care experience of children and 
working age adults with significant disability including persons with 
physical disabilities, the MR/DD population, and persons with serious 
mental illness. Questions of interest include:
     What measures or indicators can be used to group people 
with disabilities in ways that are clinically meaningful? How can these 
measures be applied to [[Page 25923]] managed care settings? What are 
the strengths and limitations of such measures and how does this effect 
their potential usefulness?
     What conditions, health care consumption patterns or other 
indicators are particularly good markers of severe disability in 
working age adults and in children?
     How do managed care providers identify high-risk people 
with special care needs who may require intensive care management?
     What do we know about the prevalence and participation of 
various groups of disabled persons in both public and private managed 
care arrangements? What are the characteristics of enrollees vs. those 
enrolled in fee-for-service, including the nature and severity of their 
conditions?

B. Impact on Access, Service Use, and Expenditures

    Some aspects of managed care have the potential to be more 
advantageous than traditional fee-for-service arrangements for people 
with disabilities. Managed care plans can ensure providers more 
discretion than the traditional fee-for-service system in allocating 
resources. Theoretically, the ability to access a more comprehensive 
range of services and providers can enhance continuity of care, 
coordination, and appropriateness of services provided. However, many 
aspects of managed care are potentially disadvantageous to people with 
disabilities. The major concern is that more emphasis on cost savings 
will translate into greater risk for less care or inappropriate care 
for the most vulnerable populations.
    Cost-effectiveness remains a critical feature of managed care in 
that it claims to achieve measurable cost savings for people with 
disabilities through better care management and the substitution of 
lower for higher cost services. Unfortunately, there are few data to 
inform either public payers or health plans about whether such cost 
savings can be realized. Within this issue area, the following types of 
questions are pertinent:
Access and Service Use
     What types of health benefits and related services do 
people with disabilities receive in current managed care systems? What 
variables best explain variation in service use? How does service use 
vary among the most prevalent disabling conditions? by indicators of 
functioning?
     How does managed care affect health service utilization 
patterns when compared to fee-for-service? To what extent do people 
with disabilities enrolled in managed care systems have improved access 
to benefits, services and/or more flexible services delivery patterns?
     Is there any evidence of substitution of certain services 
as a result of managed care practices (e.g. preventive care and 
rehabilitation for other services such as in-patient care and emergency 
room services)?
     To what extent do managed care plans favor physician and 
hospital services over home health care and rehabilitation services?
     How does access to services by disabled enrollees in 
managed care vary by payment source, type of managed care plan and 
severity of disabling condition?
Public and Private Health Care Expenditures
     What are the health care expenditures of people with 
disabilities in managed care arrangements and how do they compare to 
the fee-for-service system? How do these expenditures vary according to 
source of payment, disabling condition, level of functioning/need, date 
of onset of disabling condition?
     What factors most contribute to the costs of health care 
for the disabled? Which are most susceptible to modification?
     Are there cost savings associated with managed care use 
for disabled persons and how are they achieved? Are some types of 
managed care plans more effective than others in realizing cost 
savings?
     What impact does managed care have on total, out of pocket 
and per capita expenditures for disabled populations, and how does this 
vary among different disabled groups (i.e., mentally ill, mentally 
retarded/developmentally disabled, physically disabled, children, 
adults)?
     How do different cost sharing arrangements under managed 
care impact on access and utilization for people with disabilities?
     Is there any evidence that managed care plans serving 
people with disabilities in either the public or private sector shift 
costs to open ended payment systems such as Medicaid institutional and 
community based services and programs, state funded programs and 
community hospitals?
     How do financing sources such as private insurance, 
Medicaid, workman's compensation and short-term disability insurance 
interest with one another in financing services for disabled 
populations enrolled in managed care?

C. Quality and Outcomes

    A fundamental question for the disability community and for state 
and federal policy makers is whether managed health care provides 
quality services and produces satisfactory outcomes for people with 
special health care needs. To address this question requires an 
understanding of what the basic health care needs of the disabled 
actually are and what services in what amounts are more or less 
effective in meeting these needs.
    Of particular importance in addressing the above issue is finding 
outcome measures which can be applied to populations whose 
characteristics and needs are quite distinct from one another. For 
example, the needs of people with physical disabilities are likely to 
be markedly different than persons with chronic mental illness. One 
approach to this issue is to examine the impact of health services on 
the functioning of people with chronic health care conditions. 
Questions in this research area include:
Quality
     What disability-specific performance measures do managed 
care plans employ to assess how well they are doing with special needs 
populations, and what are the results of applying these measures? Are 
there satisfaction measures that specifically address the concerns of 
disabled individuals, and how do they compare to measurement of 
satisfaction in non-disabled populations?
     How do states monitor the performance of managed care 
arrangements in which they enroll significant numbers of disabled 
persons and how does such monitoring affect the quality of services for 
disabled beneficiaries?
Outcomes of Disabled in Managed Care
     What measures are the most useful in predicting outcomes 
for people with disabilities in managed care? To what extent should 
they be condition specific or specific to a particular disabled 
category? Can these outcomes be linked to the presence/absence of 
specific services and treatments? If so, what measures of performance 
are created and how well do managed care plans rate on such measures? 
To what extent can their performance be compared with the fee-for-
service system?
     What impact does managed care have on level of functioning 
of persons with disabilities? Is this a good measure of quality of care 
received?
     How does managed care plans compare to fee-for-service 
plans [[Page 25924]] compare in areas of mortality and morbidity, 
enrollment and disenrollment, and satisfaction, for comparably-disabled 
populations? Are some types of managed care plans better performers 
than others (e.g., specialized programs vs. plans where the disabled 
are a small subset of enrollees, PPOs vs. HMOs)? Are sub-populations of 
the disabled community better or worse off under managed care (i.e. 
children with functional impairments, adults with cognitive and mental 
impairments, adults with significant physical disabilities)?

D. Financing and Reimbursement

    Financial incentives which would encourage health plans and 
providers to include people with significant disabilities in managed 
care are largely lack in today's system. In the absence of such 
incentives, managed care plans can improve their financial results by 
selecting ``good risks'' while avoiding bad ones.
    Providers who encourage the enrollment of disabled individuals in 
plans that are fully capitated face significant challenges. First, 
there is little empirical basis for predicting the added costs (if any) 
of serving a population with disabilities. To the extent that a managed 
care plan or provider does try to cover more high risk populations in 
private plans, premium rates must be adjusted or the plan could end up 
losing money. However, if premium rates are adjusted too high, more 
health participants will opt out of the plan. Within this issue area, 
the following types of questions are pertinent:
     How are capitation rates sets for health plans enrolling 
significant numbers of people with disabilities? How and to what extent 
are disability characteristics taken into account in setting such 
rates? How well do the rates work for all interested parties?
     How do different risk sharing mechanisms affect the 
willingness/capacity of the managed care plan to enroll disabled 
populations and insure access to a broader range of services for 
disabled populations (e.g., risk pools, reinsurance, sharing costs with 
other payers, etc.)?
     What are the advantages and disadvantages of various risk 
sharing arrangements? How do various arrangements affect service use 
patterns and outcomes of care?
     What are some of the more promising strategies, or 
insurance market reforms, to offset the incentives of managed care 
plans to select out potentially high risk persons?

E. Organization of the Delivery System

    Greater attention is necessary to determine how managed care plans 
should be organized to address the needs of people with disabilities. 
Whether plans which specialize in disability will work better than 
plans which include the disabled in a larger, healthier population of 
enrollees is not clear. Another key design issue in organizing managed 
care systems for people with disabilities is the extent to which and 
how long term care services should be integrated/coordinated with acute 
care services, given that people with significant disabilities may need 
access to both. The incentives created by leaving one system open-ended 
while the other is capped are obvious. In addition, there are a variety 
of models of managed care, and it remains unclear whether some are 
better than others in providing beneficiaries with good quality 
services without exposing the plan to unacceptable financial risk. 
While this issue area, the following types of questions are pertinent:
     What are the advantages and disadvantages of specialized 
managed care plans which only serve the disabled compared with general 
plans which incorporate the disabled in a larger population of 
healthier persons in terms of benefits and costs?
     Which managed care models (e.g., staff and group HMOs, 
PPOs, open panel HMOs) are more (or less) effective in serving people 
with special needs and to the extent they are more effective. how do 
they do it?
     What differences are there in outcomes and consumer 
satisfaction when services are integrated vertically versus through 
networking strategies?
     To what extent do managed care plans serving people with 
disabilities coordinate their benefits with the long term care system?
     What non-financial incentives are important to encouraging 
health plans to offer more comprehensive services to people with 
disabilities?
     How do managed care plans manage care for those people 
consuming the most services?

F. Requirement of All Potential Grantees

    Part of the resultant grant, we requiring that grantees commit 
participate in a one-day meeting in Washington with a Technical 
Advisory Group. All applicants will be required to attend a Technical 
Advisory Group (TAG) meeting upon completion of the two year grant 
award cycle, regardless of the fact that some awards may be completed 
prior to two years. The TAG, comprised of experts on disability and 
managed care, will integrate the various components of the ASPE 
research strategy described in Section II. The Government will to pay 
for travel to and from Washington for this TAG regardless of whether 
the grant period has ended or remains in effect.

Part III. Application Preparation and Evaluation Criteria

    This part contains information on the preparation of an application 
for submission under this announcement, the forms necessary for 
submission and the evaluation criteria under which the applications 
will be reviewed. Potential applicants should read this part carefully 
in conjunction with the information and questions provided in Part II.
    Applications should be assembled as follows:
    1. Abstract: Provide a one-page summary of the proposed project.
    2. Goals, Objectives, and Usefulness of Project: Include an 
overview which describes the need for the proposed project; indicates 
the background and policy significance of the issue area(s) to be 
researched including a critique of related disability specific studies; 
outlines the specific quantitative and qualitative questions to be 
investigated; and describes how the proposed project will advance 
scientific knowledge and policy development on the impact of managed 
care on people with disabilities.
    3. Methodology and Design: Provide a description and justification 
of how the proposed research project will be implemented, including 
methodologies, approach to be taken, data sources to be used, and 
proposed research and analytic plans. Identify any theoretical or 
empirical basis for the methodology and approach proposed. In addition, 
provide evidence of access to data set(s) proposed to be studied.
    Proposals, where data sets permit, should address the areas 
highlighted in Section II as well as the following quantitative and 
qualitative issues:
     Utilization of services--both volume and mix of services;
     Tracer measures of specific conditions (e.g., readmission 
for mental diagnosis, prophylactic treatment for AIDS cases, use of 
rehabilitative services);
     Selection bias;
     Enrollment trends of disabled individuals in managed car 
organizations, including reasons for disenrollment;
     Outcome analyses such as mortality rates, use of emergency 
services, changes in functional status, satisfaction information, and 
hospital readmissions; [[Page 25925]] 
     Overall health care expenditures by disabled groups;
     Cost savings practice patterns (e.g., referrals to cost-
effective providers, specialized case management practices, provider 
discounted fees, concurrent utilization review practices);
     Access to specialty care;
     Benefit package (e.g., long-term rehabilitation services, 
durable medical equipment);
     Availability of specialty providers;
     Coordination with auxiliary services;
     Risk sharing mechanisms;
     Risk adjustment and capitation rate development;
     Coordination and integration of services.
    4. Experience of Personnel/Organizational Capacity: Briefly 
describe the applicant's organizational capabilities and experience in 
conducting pertinent research projects. Identify the key staff who are 
expected to carry out the research project and provide a curriculum 
vitae for each person. Provide a discussion of how key staff will 
contribute to the success of the project.
    5. Budget: Submit a request for Federal funds using Standard Form 
424A and provide a proposed budget using the categories listed on this 
form.

Review Process and Funding Information

    A panel of at least three independent experts will review and score 
all applications that are submitted by the deadline date and which meet 
the screening criteria (all information and documents as required by 
this Announcement.) The panel will review the applications using the 
evaluation criteria listed below to score each application. These 
evaluation criteria will be the primary elements used by the ASPE in 
making funding decisions.
    HHS reserves the option to discuss applications with other Federal 
agencies, Central or Regional Office staff, specialists, experts, 
States and the general public. Comments from these sources, along with 
those of the independent experts, may be considered in making an award 
decision.

State Single Point of Contact (E.O. No. 12372)

    The Department of Health and Human Services has determined that 
this program is not subject to Executive Order No. 12372, 
Intergovernmental Review of Federal Programs, because it is a program 
that is national in scope and the only impact on State and local 
governments would be through subgrants. Applicants are not required to 
seek intergovernmental review of their applications with the 
constraints of E.O. No. 12372.

Deadline for Submission of Application

    The closing date for submission of applications under this 
announcement is July 14, 1995. Applications must be postmarked or hand-
delivered to the application receipt point no later than 4:30 p.m. on 
July 14, 1995.
    Hand-delivered applications will be accepted Monday through Friday 
prior to and on July 14, 1995. During the hours of 9:00 a.m. to 4:30 
p.m. in the lobby of the Hubert H. Humphrey building located at 200 
Independence Avenue, SW., in Washington, DC. When hand-delivering an 
application, call 690-8794 from the lobby for pick-up. A staff person 
will be available to receive applications.
    An application will be considered as meeting the deadline if it is 
either: (1) Received at, or hand-delivered to, the mailing address on 
or before July 14, 1995, or (2) on the closing date of receipt from 
applications and received in time to be considered during the 
competitive review process (within two weeks of the deadline date).
    When mailing application packages, applicants are strongly advised 
to obtain a legibly dated receipt from a commercial carrier (such as 
UPS, Federal Express, etc.), or from the U.S. Postal Service as proof 
of mailing by the deadline date. If there is a question as to when an 
application was mailed, applicants will be asked to provide proof of 
mailing by the deadline date. When proof is not provided, an 
application will not be considered for funding. Private metered 
postmarks are not acceptable as proof of timely mailing.
    Applications which do not meet the July 14, 1995 deadline are 
considered late applications and will not be considered or reviewed in 
the current competition. HHS will send a letter to this effect to each 
late applicant.
    HHS reserves the right to extend the deadline for all applications 
due to acts of God, such as floods, hurricanes or earthquakes; due to 
acts of war; if there is widespread disruption of the mail; or if HHS 
determines a deadline extension to be in the best interest of the 
Government. However, HHS will not waive or extend the deadline for any 
applicant unless the deadline is waived or extended for all applicants.

Applications Forms

    See section entitled ``Components of a Complete Application.'' All 
of these documents must accompany the application package.

Length of Application

    Applications should be as brief and concise as possible, but assure 
successful communication of the applicant's proposal to the reviewers. 
In no case shall an application (excluding the resume appendix and 
other appropriate attachments) be longer than 30 single spaced pages; 
it should neither be unduly elaborate nor contain voluminous supporting 
documentation.

Selection Process and Evaluation Criteria

    Selection of the successful applicant(s) will be based on the 
technical criteria laid out in this announcement. Reviewers will 
determine the strengths and weaknesses of each application in terms of 
the evaluation criteria listed below, provide comments and assign 
numerical scores. The review panel will prepare a summary of all 
applicant scores and strengths/weaknesses and recommendations and 
submit it to the ASPE for final decisions on award(s).
    The point value following each criterion heading indicates the 
maximum numerical weight that each section will be given in the review 
process. An unacceptable rating on any individual criterion may render 
the application unacceptable. Consequently, applicants should take care 
to ensure that all criteria are fully addressed in the applications. 
Applications will be reviewed as follows:
    Applications will be initially screened for compliance with the 
timeliness and completeness. If judged in compliance, the application 
then will be reviewed by government personnel, augmented by outside 
experts where appropriate. Three (3) copies of each application are 
required. Applicants are encouraged to send an additional three (3) 
copies of their application to ease processing, but applicants will not 
be penalized if these extra copies are not included. The length of the 
application is limited to 30 single spaced pages; extraneous materials 
such as videotapes and brochures should not be included and will not be 
reviewed.

Evaluation criteria

    1. Goals, Objectives, and Potential Usefulness of the Quantitative 
and Qualitative Analyses (30 points). The potential usefulness of the 
objectives and how the anticipated results of the proposed project will 
advance scientific knowledge and policy development on the impact of 
managed care on disabled populations.
    2. Methodology and Design (35 points). The appropriateness, 
[[Page 25926]] soundness, and cost-effectiveness of the methodology, 
including research design, statistical techniques, analytical 
strategies, degree of inclusion of utilization, cost and functional 
data and information, innovative and creative selection of existing 
data sets, and other procedures. The applicant is encouraged to 
specifically address how they intend, when applicable, to examine the 
quantitative and qualitative areas previously outlined.
    3. Experience and Qualifications of Personnel (35 points). The 
qualifications and experience of the project personnel for conducting 
the proposed research and indications of innovative approaches and 
creative potential

Reports

    The grantee must submit annual progress reports and a final report. 
The specific format and content for these reports will be provided by 
the project officer.

Disposition of Applications
    1. Approval, disapproval, or deferral. On the basis of the review 
of an application, the ASPE will either (a) approve the application in 
whole, as revised, or in part for such amount of funds and subject to 
such conditions as are deemed necessary or desirable for the research 
project; (b) disapprove the application; or (c) defer action on the 
application for such reasons as lack of funds or a need for further 
review.
    2. Notification of disposition. The ASPE will notify the applicants 
of the disposition of their application. A signed notification of award 
will be issued to notify the applicant of the approved application.

Components of a Complete Application

    A complete application consists of the following items in this 
order:
    1. Application for Federal Assistance (Standard Form 424, Revised 
4-88);
    2. Budget Information--Non-construction Programs (Standard Form 
424A, Revised 4-88);
    3. Assurances--Non-construction Programs (Standard Form 424B, 
Revised 4-88);
    4. Table Contents;
    5. Budget Justification for Section B--Budget Categories;
    6. Proof of non-profit status, if appropriate;
    7. Copy of the applicant's approved indirect cost rate agreement if 
necessary;
    8. Project Narrative Statement, organized in five sections 
addressing the following topics;
    (a) Understanding of the Effort,
    (b) Project Approach,
    (c) Staffing Utilization, Staff Background, and Experience,
    (d) Organizational Experience, and
    (e) Budget Narrative;
    9. Any appendices/attachments;
    10. Certification Regarding Drug-Free Workplace;
    11. Certification Regarding Debarment, Suspension and Other 
Responsibility Matters; and
    12. Certification and, if necessary, Disclosure Regarding Lobbying;
    13. Application for Federal Assistance Checklist.

    Dated: May 3, 1995.
David T. Ellwood,
Assistant Secretary for Planning and Evaluation.
[FR Doc. 95-11832 Filed 5-12-95; 8:45 am]
BILLING CODE 4151-04-M