[Federal Register Volume 61, Number 141 (Monday, July 22, 1996)]
[Notices]
[Pages 37917-37921]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-18442]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Availability of Funds for Grants to Provide Health Care for the
Homeless and Health Care Services for Homeless Children
AGENCY: Health Resources and Services Administration, HHS.
ACTION: Notice of available funds.
-----------------------------------------------------------------------
SUMMARY: The Health Resources and Services Administration (HRSA)
announces that the President's budget for fiscal year (FY) 1997
includes approximately $65.4 million for discretionary grants to
provide primary health and substance abuse services to homeless
individuals. These grants will be awarded under Section 340 of the
Public Health Service (PHS) Act, 42 U.S.C. 256. This announcement is
made prior to an appropriation of FY 1997 funds, to allow applicants
sufficient time to prepare applications and to enable timely award of
the grants in consideration of the special needs of homeless
individuals. Approximately $6.3 million will be used to fund
continuation of services where there is an expiring project period.
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
[[Page 37918]]
Office, Washington, D.C. 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.
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 DATE: Applications are due 120 days prior to project end date, with
the first due date being August 1, 1996 and the last date being March
1, 1997. However, to allow potential applicants sufficient time to
prepare application materials for those areas in which grants are
expiring on October 31, 1996, applications for grants beginning
November 1, 1996 will be due 90 days prior to the expiration of the
current grant award or no later than August 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 the appropriate PHS Regional Grants
Management Officer (RGMO) (see Appendix A). The RGMO can also provide
assistance on business management issues.
FOR FURTHER INFORMATION CONTACT: For general program information and
technical assistance, contact Ms. Jean Hochron, Chief, Health Care for
the Homeless Branch, Division of Programs for Special Populations,
Bureau of Primary Health Care (BPHC), at 4350 East-West Highway,
Bethesda, Maryland 20814 (telephone 301-594-4430).
ELIGIBLE APPLICANTS: It is the intent of HRSA to continue to support
health services to the homeless populations currently being served
given the needs of this medically underserved population. Any nonprofit
private organization or public entity may apply to serve the homeless
population currently served by a grantee whose project period is
expiring. For a list of service areas with expiring project periods,
see Federal Register notice published on June 17, 1996, at 61 FR 30622.
SUPPLEMENTARY INFORMATION: It is anticipated that approximately 16
Health Care for the Homeless and 1 Health Care Services for Homeless
Children competing grants will be awarded to serve homeless individuals
in urban and rural areas. Grants will range from approximately $88,000
to approximately $1.2 million for primary health care and substance
abuse services.
A project period is the total amount of time for which a grant has
been programmatically approved. For purposes of this notice, grant
awards will be made for a one year budget period and up to a five year
project period.
Grants Awarded Under Section 340(a)
Section 340(a) of the PHS Act authorizes the Secretary to award
grants to enable grantees, directly or through contracts, to provide
for the delivery of primary health services to homeless individuals.
Eligible applicants are nonprofit private organizations and public
entities, including State and local governmental agencies. Grantees and
organizations with whom they may contract for services under this
program 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.
For grantees not previously funded under section 340(a), the amount
of Federal grant funds awarded may not exceed 75 percent of the costs
of providing primary health and substance abuse services under the
grant. Such newly funded grantees must make available non-Federal
contributions to meet the remainder of the costs. Existing 340(a)
grantees, if funded, must make available 33\1/3\ percent non-Federal
contributions to meet the remainder of the costs. Non-Federal
contributions may be in cash or in-kind, fairly evaluated, including
plant, equipment or services. Funds 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
the non-Federal contributions. Such determination may not include any
cash or in-kind contributions that, prior to February 26, 1987, were
made available by any public or private entity for the purpose of
assisting homeless individuals (including assistance other than the
provision of health services). The Secretary may waive the matching
requirement if the grantee is a nonprofit private entity and the
Secretary determines that it is not feasible for the grantee to comply
with the requirement.
The grant may be used to continue to provide services listed below
for up to 12 months to individuals who have obtained permanent housing
if services were provided to these individuals when they were homeless.
For the purpose of this program, the term ``homeless individual'' means
an individual who lacks housing (without regard to whether the
individual is a member of a family), including an individual whose
primary residence during the night is a supervised public or private
facility that provides temporary living accommodations, or an
individual who is a resident in transitional housing.
Project Requirements
a. The following services must be provided, directly or through
contract:
1. Primary health care and substance abuse services at locations
accessible to homeless individuals;
2. 24-hour emergency primary health and substance abuse services to
homeless individuals;
3. Referral of homeless individuals as appropriate to medical
facilities for necessary hospital services;
4. Referral of homeless individuals who are mentally ill to
entities that provide mental health services, unless the applicant will
provide such services directly;
5. Outreach services to inform homeless individuals of the
availability of primary health and substance abuse services;
6. Aid to homeless individuals in establishing eligibility for
assistance, and in obtaining services, under entitlement programs.
7. Podiatry, dental (including dentures), and vision services are
supplemental services and may be provided where medically necessary, to
the extent that the level of delivery of the required services is not
diminished.
Grants Awarded Under Section 340(s)
Section 340(s) of the PHS Act authorizes the Secretary to carry out
demonstration programs to enable
[[Page 37919]]
entities, either directly or through contracts, to provide for the
delivery of comprehensive primary health services to homeless children
and to children at imminent risk of homelessness. Eligible applicants
are grantees funded under 340(a) of the PHS Act, other public and
nonprofit private entities that provide primary health services and
substance abuse services to a substantial number of homeless
individuals, and public nonprofit private children's hospitals that
provide primary health services to a substantial number of homeless
individuals. Grantees and organizations with which they may contract
for services under this program 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.
For grantees under this program which are children's hospitals, the
amount of Federal grant funds awarded may not exceed 50 percent of the
costs of providing primary health and substance abuse services under
the grant. Grantees which are children's hospitals must make available
non-Federal contributions to meet the remainder of the costs. Non-
Federal contributions may be in cash or in-kind, fairly evaluated,
including plant, equipment or services. Funds 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 the non-Federal contributions.
Project Requirements
a. The following services must be provided directly or through
contract:
1. Comprehensive primary health services, including such services
provided through mobile medical units;
2. Referrals for provision of health services, social services, and
education services, including referral to hospitals, community and
migrant health centers, Head Start and other education programs, and
programs for prevention and treatment of child abuse; and
3. Outreach services to identify children who are homeless or at
imminent risk of homelessness and to inform parents/guardians of the
availability of services directly from the grantees and through the
referral mechanism.
Other Grant Requirements Applicable to Both Sections 340(a) and
340(s) Grantees
a. 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 and substance abuse services or mental
health services.
3. Grants funds may not be used to purchase or improve real
property (other than minor remodeling of existing improvements to real
property) or to purchase major medical equipment, including mobile
medical units. However, upon request by an applicant demonstrating that
the purposes of the project cannot otherwise be carried out, the
Secretary may waive this restriction.
b. 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 homeless individual with an
income less than the official poverty level (the nonfarm income
official poverty line defined by the Office of Management and Budget);
(3) will be adjusted to reflect the income and resources of the
homeless individual involved.
Additional Grant Requirements for Section 340(a) Only
a. The grantee may not expend more than 10 percent of grant funds
for the purpose of administering the grant.
b. The grantee may, with respect to title I of the Protection and
Advocacy for Mentally Ill Individuals Act of 1986, expend amounts
received for the purpose of referring homeless individuals who are
chronically mentally ill, and who are eligible under the Act, to
systems that provide advocacy services under the Act.
c. The grantee may provide services through contracts with
nonprofit selfhelp organizations that are established and managed by
current and former recipients of mental health or substance abuse
services, who have been homeless individuals; and that 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 qualify to receive payments
under the agreement.
Criteria for Evaluating Applications for Section 340(a) and 340(s)
Competing Applications 340(a)
These competitive applications for grant support will be reviewed
based upon the following evaluation criteria:
a. Compliance with the requirements of section 340(a) of the PHS
Act and other programmatic requirements;
b. Experience in providing primary health or substance abuse
services to homeless individuals or medically underserved populations.
c. Extent to which the applicant has identified the homeless
population in the service area, including the social and demographic
characteristics of the population and the extent to which their health
needs are not being met;
d. Adequacy of the applicant's outreach plan to serve the homeless
population;
e. Extent to which primary health and substance abuse services are
to be provided to homeless individuals in a manner that demonstrates
program linkages and services integration;
f. Adequacy of the applicant's referral arrangement to appropriate
medical facilities for hospitalization and, for individuals who are
mentally ill, to entities that provide mental health services, unless
the applicant will provide such services directly;
g. Extent to which the applicant has the ability to involve
appropriate community representatives to ensure that the program is
culturally appropriate and accommodates the needs of homeless
individuals in the service area;
h. Extent to which the applicant has engaged or plans to engage
with other entities in an integrated service system in the community;
i. Qualifications and experience of the proposed project staff;
i.e., the staff size and skills necessary to carry out an effective
program;
j. Adequacy of the proposed budget; i.e., detailed estimates of
revenue and costs in accordance with grant application instructions;
k. Evidence of administrative procedures for fiscal control and
fund accounting procedures which provide for reasonable financial
administration of Federal and non-Federal funds;
l. Evidence of an ongoing program of quality assurance with respect
to health services provided under the grant;
m. Evidence of a reasonable plan for communicating with non-English
speaking homeless individuals provided health services under the grant;
[[Page 37920]]
n. Indication of strategies for collaborative relationships and
linkages which maximize effective use of existing health and social
service resources, especially those of state and local health
department, primary care providers to the underserved, and academic
institutions; and
o. A current grantee's progress in achieving stated goals and
objectives for the previous year's grant.
Competing Applications 340(s)
These competitive applications for grant support will be reviewed
based upon the following evaluation criteria:
a. Compliance with the requirements of section 340(s) of the PHS
Act and other programmatic requirements;
b. Experience in providing primary health or substance abuse
services to homeless individuals or medically underserved populations;
c. Extent to which the applicant has identified homeless children
and children at imminent risk of homelessness within the service area,
including the social and demographic characteristics of these children
and the extent to which their health needs are not being met;
d. Proposal of an innovative approach to meeting the health care
needs of homeless children and children at imminent risk of
homelessness, which can be utilized as a demonstration site for other
programs nationally;
e. Adequacy of the applicant's outreach plan to identify homeless
children and children at imminent risk of homelessness and inform their
parents/guardians of the availability of services;
f. Extent to which primary health services are to be provided to
homeless children in a linked and integrated manner;
g. Adequacy of the applicant's referral arrangements for the
provision of health services, social services, and education services,
including referral to hospitals, community and migrant health centers,
Head Start and other educational programs, and programs for prevention
and treatment of child abuse;
h. Extent to which the applicant has the ability to involve
appropriate community representatives to ensure that the program
accommodates the needs of homeless children and children at imminent
risk of homelessness in the service area;
i. Extent to which the applicant has engaged or plans to engage
with other entities in an integrated service system in the community;
j. Qualifications and experience of the proposed project staff;
i.e., the staff size and skills necessary to carry out an effective
program;
k. Adequacy of the proposed budget; i.e., detailed projections of
revenue and costs in accordance with grant application instructions;
l. Evidence of administrative procedures for fiscal control and
fund accounting procedures which provide for reasonable financial
administration of Federal and non-Federal funds;
m. Evidence of an ongoing program of quality assurance with respect
to health services provided under the grant;
n. Evidence of a reasonable plan for communicating with non-English
speaking children provided health services under the grant and their
parents/guardians; and
o. Indication of strategies for collaborative relationships and
linkages which maximize effective use of existing health and social
service resources, especially those of state and local health
department, primary care providers to the underserved, and academic
institutions.
p. A current grantee's progress in achieving stated goals and
objectives for the previous year's grant.
Other Award Information
The Health Care for the Homeless program 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.)
Public Health System Reporting Requirement
Section 340 general primary care services delivery grants are
subject to the Public Health System Reporting Requirement, PHS 92.01.
Reporting requirements have been approved by the OMB under control
numbers 0937-0195. Under this requirement, 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.
Applicants may submit the Project Summary section of the application as
the PHSIS. Community-based nongovernmental applicants are required to
submit a copy of the face page of the application (SF 424) 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. In the
OMB Catalog of Federal Domestic Assistance, the Health Care for the
Homeless program is listed as Number 93.151.
Dated: July 16, 1996.
Ciro V. Sumaya,
Administrator.
Appendix A
Region I
(CT, ME, MA, NH, RI, VT)
Grants Management Officer, PHS Office of Grants Management, John F.
Kennedy Federal Bldg. #1400, Boston, Massachusetts 02203, (617) 565-
1426
Region II
(NJ, NY, PR, VI)
Grants Management Officer, PHS Office of Grants Management, 26
Federal Plaza #3337, New York, New York 10278, (212) 264-2549
Region III
(DE, DC, MD, PA, VA, WV)
Grants Management Officer, PHS Office of Grants Management, 3535
Market Street #10-140, Philadelphia, Pennsylvania 19101, (215) 596-
6655
Region IV
(AL, FL, GA, KY, MS, NC, SC, TN)
Grants Management Officer, PHS Office of Grants Management, 101
Marietta Tower, Suite 1121, Atlanta, Georgia 30323, (404) 331-2597
Region V
(IL, IN, MI, MN, OH, WI)
Grants Management Officer, PHS Office of Grants Management, 105 West
Adams,
[[Page 37921]]
17th Floor, Chicago, Illinois 60603, (312) 353-8700
Region VI
(AR, LA, NM, OK, TX)
Grants Management Officer, PHS Office of Grants Management, 1200
Main Tower Bldg. #1800, Dallas, Texas 75202, (214) 767-3885
Region VII
(IA, KS, MO, NE)
Grants Management Officer, PHS Office of Grants Management, 601 East
12th Street #501, Kansas City, Missouri 64106, (816) 426-5841
Region VIII
(CO, MT, ND, SD, UT, WY)
Grants Management Officer, PHS Office of Grants Management, 1961
Stout St., Fed. Bldg. #492, Denver, Colorado 80294, (303) 844-4461
Region XI
(AS, AZ, CA, GU, HI, NV, TT)
Grants Management Officer, PHS Office of Grants Management, 50
United Nations Plaza #331, San Francisco, California 94102, (415)
437-8125
Region X
(AK, ID, OR, WA)
Grants Management Officer, PHS Office of Grants Management, 2201 6th
Avenue, #710, Seattle, Washington 98121, (206) 615-2474
[FR Doc. 96-18442 Filed 7-19-96; 8:45 am]
BILLING CODE 4160-15-P
