[Federal Register Volume 59, Number 57 (Thursday, March 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6859]
[[Page Unknown]]
[Federal Register: March 24, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Availability of Funds for Grants To Provide Outpatient Early
Intervention Services With Respect to HIV Disease
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 that the appropriation for fiscal year (FY) 1994 includes
approximately $47.9 million for discretionary grants to provide
outpatient early intervention services including primary care services
with respect to human immunodeficiency virus (HIV) disease. These
grants are awarded under the provisions of subpart II and subpart III
of part C of title XXVI of the Public Health Service (PHS) Act, as
amended by the Ryan White Comprehensive AIDS Resources Emergency (CARE)
Act of 1990, Public Law 101-381 (42 U.S.C. 300ff-51-300ff-67).
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 following priority areas: increase the proportion of HIV-
infected persons who are tested; increase the proportion of primary
health care providers who provide age-appropriate HIV counseling; and
increase the proportion of family planning and primary health care
providers who provide a comprehensive HIV program. Potential applicants
may obtain a copy of Healthy People 2000 (Full Report; Stock No. 017-
001-00474-0) or Healthy People 2000 (Summary Report; Stock No. 017-001-
00473-1) through the Superintendent of Documents, Government Printing
Office, Washington, DC 20402-9325 (telephone 202-783-3238).
The Public Health Service 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.
ADDRESSES: Application kits (Form PHS 5161-1 with revised face sheet
HHS Form 424, as approved in 7/92 by the Office of Management and
Budget (OMB) 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). The RGMO can
also provide assistance on business management issues.
DATES: In order to receive consideration, applications for competing
continuation and/or new grants with September 30, 1994 budget start
dates should be received by the RGMO by June 1, 1994. Applications will
be considered to be ``on time'' if they are either: (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 request a legibly dated U.S. Postal Service postmark
or obtain a legibly dated receipt from a commercial carrier or the U.S.
Postal Service. Private metered postmarks will not be acceptable as
proof of timely mailing.) Late applications will not be considered for
funding and will be returned to the applicant.
FOR FURTHER INFORMATION CONTACT: For general program information and
technical assistance, contact Joan Holloway, Director, Division of
Programs for Special Populations, Bureau of Primary Health Care (BPHC),
at 4350 East-West Highway, 9th floor, Rockville, Maryland 20857
(telephone 301-594-4444). Questions can also be directed to the PHS
regional offices listed in the appendix.
SUPPLEMENTARY INFORMATION:
Number of Awards
It is anticipated that $17.9 million will be available to make
awards to approximately 49 competing continuation and/or new applicants
for grants with September 30, 1994, budget start dates. The range of
project support is approximately $100,000-$500,000. The budget period
will be for 12 months. Continuation awards for any future years will be
made subject to the availability of funds and satisfactory performance
in past budget years toward meeting the goals and objectives of the
project.
Eligible Applicants
Eligible applicants are public entities and nonprofit private
entities that are: migrant health centers under Section 329 of the PHS
Act; community health centers under Section 330 of the PHS Act; health
care for the homeless grantees under Section 340 of the PHS Act; family
planning grantees under Section 1001 of the PHS Act other than States;
comprehensive hemophilia diagnostic and treatment centers; federally-
qualified health centers under section 1905(1)(2)(B) of the Social
Security Act; or public and private nonprofit entities that currently
provide comprehensive primary care services to populations at risk of
HIV disease.
Funding under this grant program is intended to increase the
capacity and accessibility of the specified entities to offer a higher
quality and a broader scope of HIV-related early intervention services
to a greater number of people in their service areas who are at risk of
HIV infection. The program must provide the services specified in the
statute (sections 2651, 2661, 2662) and may provide for a set of other
optional services.
The required services to be provided under this grant are:
Comprehensive individual counseling regarding HIV disease
according to specific statutory mandates for the content and conduct of
pretest counseling, counseling of those with negative test results,
counseling of those with positive results, and with attention to the
appropriate setting for all counseling;
Testing individuals with respect to HIV disease, in
laboratories certified by the Clinical Laboratories Improvement
Amendments, including tests to confirm the presence of the disease,
tests to diagnose the extent of the deficiency in the immune system,
and tests to provide information on appropriate therapeutic measures
for preventing and treating the deterioration of the immune system and
for preventing and treating conditions arising from the disease;
Referral to appropriate providers of health and support
services, including, as appropriate to entities funded under parts A
and B of title XXVI of the PHS Act, to biomedical research facilities,
community-based organizations or other entities that offer experimental
treatment for HIV disease, and to grantees under 2671 for the care of
pregnant women;
Other clinical and diagnostic services regarding HIV
disease, and periodic medical evaluations of individuals with the
disease; and
Providing therapeutic measures for preventing and treating
the deterioration of the immune system and for preventing and treating
conditions arising from the disease.
Optional services that may be included if they can be shown to be
essential to the delivery of care are:
Outreach, case management, and counseling for eligibility
for other health services.
Applicants, or providers acting under an agreement with the
applicant, must be participating and qualified providers under the
State Medicaid plan approved under title XIX of the Social Security
Act; a waiver procedure is available from BPHC. Grantees are required
to maximize service reimbursements from private insurance, Medicare,
other Federal programs, and other third-party payment sources.
The applicant must agree that the services provided will conform to
the assurances and agreements required under the statute that:
The applicant will participate in an HIV care consortium
established pursuant to part B, title XXVI, if such a consortium
exists.
Hemophilia services will be provided through the network
of regional comprehensive hemophilia diagnostic and treatment centers.
The applicant will ensure confidentiality of patient
information.
Testing will be provided only after obtaining a statement
that the testing is done after counseling has been conducted and that
the decision of the individual to undergo testing is voluntarily made.
Opportunities for anonymous testing will be provided.
Individuals seeking services will not have to undergo
testing as a condition of receiving other health services.
A sliding fee schedule with the limits established in the
statute will be utilized.
Funds will not be expended for services covered, or which
could reasonably be expected to be covered, under any State
compensation program, insurance policy, or under any Federal or State
health benefits program, or by an entity that provides health services
on a prepaid basis.
Funds will be expended only for the purposes awarded, and
such procedures for fiscal control and fund-accounting, as may be
necessary, will be established.
Counseling programs shall be designed to reduce exposure
to, and transmission of HIV disease by providing accurate information;
and shall provide information on the health risks of promiscuous sexual
activity and injecting drug use.
A limit of 5 percent of the grant funds will be imposed
for administrative expenses. Funds may not be expended for
construction, inpatient care, residential care, or cash payments to
recipients of services.
The HIV Client and Program Profile, which has been
formally established as the Minimum Data Set (MDS) for BPHC, will be
submitted every 6 months. (Approved under the Paperwork Reduction Act,
OMB No. 0915-0158.)
Criteria for Evaluation
New and Competing Continuation Applications
In its review of applications for new and competing continuation
projects, BPHC will consider:
The need in the community, based on the 2-year period
preceding the proposed grant period, for additional preventive and
primary care services to those at risk for HIV infection, including
women, children, and minorities, and to persons with HIV infection;
barriers to meeting those needs within the existing service provider
system; and other information (e.g., epidemiological and health
resources data) that makes a compelling case for the grant requested as
specified in Section 2653 of the PHS Act.
The applicant's ability to describe its role within the
community in addressing the unmet needs for delivery of HIV primary
care services to the targeted populations.
The degree to which the proposed budget is appropriate to
the program plan and the degree to which coordination with other
funding sources is documented.
Comprehensiveness of the existing, plus proposed, scope of
counseling and testing, referral, primary care prevention, diagnostic
and treatment services, and optional outreach, case management, or
eligibility assistance services provided by the applicant; and
development of mechanisms to assure continuity of primary care for
persons living with HIV infection.
Extent to which actions taken assure effective
collaboration with city/county/State health department HIV prevention
activities supported by the Centers for Disease Control and Prevention,
and with State Care Consortia funded under Section 2613 of the PHS Act;
extent to which efforts are consistent with priorities of the HIV
Planning Council in the cities funded under Title XXVI of the PHS Act,
and with programs funded by other PHS agencies.
The adequacy and completeness of the program evaluation
plan, and the relationship of the evaluation plan to the goals and
objectives of the proposed program, so that effectiveness can be
measured.
In addition, for competing continuations: The degree to
which the grantee succeeded in accomplishing the goals and objectives
in the initial 3-year project period, including the extent to which HIV
primary care services were integrated into the applicant's overall
primary care program; and a record of compliance with reporting
requirements in effect during that period.
In addition, for new applicants: demonstrated ability of
the applicant organization to carry out the proposed program, including
the extent to which the proposed key clinical staff have had prior
experience in the provision of clinical care for individuals with HIV
infection.
Other Grant Information
The Grant Program to Provide Outpatient Early Intervention Services
with Respect to HIV Disease has been determined to be a program which
is subject to the provisions of Executive Order 12372, 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 application deadline date. The BPHC does not guarantee
to accommodate or explain State process recommendations it receives
after that date.
This program is subject to the Public Health System Reporting
Requirements. Reporting requirements have been 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
the following information to the head of the appropriate State and
local health agencies in the area(s) to be impacted no later than the
Federal Application receipt due date:
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 or local health agencies. Grants will be administered in
accordance with HHS Regulations in 45 CFR Part 92 for State and local
governments, or 45 CFR Part 74 for other grantees.
The OMB Catalog of Federal Domestic Assistance number for this
program is 93.918.
Dated: March 17, 1994.
Ciro V. Sumaya,
Administrator.
Appendix
Regional Grants Management Officers
Region I: Mary O'Brien, Grants Management Officer, PHS Regional
Office I, John F. Kennedy Federal Building, Boston, MA 02203, (617)
565-1482
Region II: Frank DiGiovanni, Grants Management Officer, PHS Regional
Office II, Room 3300, 26 Federal Plaza, New York, NY 10278, (212)
264-4496
Region III: Marty Bree, Grants Management Officer, PHS Regional
Office III, P. O. Box 13716, Philadelphia, PA 19101, (215) 596-6657
Region IV: Wayne Cutchens, Grants Management Officer, PHS Regional
Office IV, Room 1106, 101 Marietta Tower, Atlanta, GA 30323, (404)
331-2597
Region V: Lawrence Poole, Grants Management Officer, PHS Regional
Office V, 105 West Adams Street, 17th Floor, Chicago, IL 60603,
(312) 353-8700
Region VI: Joyce Bailey, Grants Management Officer, PHS Regional
Office VI, 1200 Main Tower, Dallas, TX 75202, (214) 767-3885
Region VII: Michael Rowland, Grants Management Officer, PHS Regional
Office VII, Room 501, 601 East 12th Street, Kansas City, MO 64106,
(816) 426-5841
Region VIII: Susan Jaworowski, Grants Management Officer, PHS
Regional Office VIII, 1961 Stout Street, Denver, CO 80294, (303)
844-4461
Region IX: Al Tevis, Grants Management Officer, PHS Regional Office
IX, 50 United Nations Plaza, San Francisco, CA 94102, (415) 556-2595
Region X: James Tipton, Grants Management Officer, PHS Regional
Office X, Mail Stop RX 20, 2201 Sixth Avenue, Seattle, WA 98121,
(206) 615-2473.
[FR Doc. 94-6859 Filed 3-23-94; 8:45 am]
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