[Federal Register Volume 59, Number 19 (Friday, January 28, 1994)]
[Unknown Section]
[Page ]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-1886]


[Federal Register: January 28, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Ryan White Title IV--HIV Demonstration Program for Children, 
Adolescents, and Families

AGENCY: Health Resources and Services Administration (HRSA), PHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Maternal and Child Health Bureau (MCHB), HRSA, announces 
that fiscal year (FY) 1994 funds are available for grants for 
demonstration projects to provide services for children, adolescents, 
women and families infected with or affected by the Human 
Immunodeficiency Virus (HIV). Projects will be funded to demonstrate 
strategies and innovative models of family-centered, community-based 
coordinated care and research for children, youth, women of 
childbearing age, and families infected and affected by HIV infection, 
AIDS or other related conditions, or those at risk for developing 
infection. Funds were appropriated for this purpose under Section 2671, 
Title IV, of the Ryan White Comprehensive AIDS Resource Emergency 
(CARE) Act of 1990, Public Law 101-381, which amended Title XXVI of the 
Public Health Service Act (42 U.S. Code 300ff-11 et seq.).
    The PHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2000, a PHS national activity 
for setting priority areas. Title IV directly addresses the Healthy 
People 2000 objectives related to the priority area of HIV infection. 
Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report; Stock Number 017-001-0474-0) 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).

ADDRESSES: Grant applications for HIV Demonstration Program for 
Children, Adolescents, and Families (PHS form #5161-1, approved under 
OMB #0937-0189) must be obtained from and submitted to: Chief, Grants 
Management Branch, Office of Program Support, Maternal and Child Health 
Bureau, Health Resources and Services Administration, room 18-12, 
Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 
443-1440.

DATES: The application deadline date is April 8, 1994. Competing 
applications will be considered to be on time if they are either: (1) 
Received on or before the deadline date, or (2) postmarked on or before 
the deadline date and received in time for orderly processing. 
(Applicants should request a legibly dated receipt from a commercial 
carrier or U.S. Postal Service postmark or obtain a legibly dated 
receipt from a commercial carrier or U.S. Postal Service. Private 
metered postmarks shall not be acceptable as proof of timely mailing.
    Late applications not accepted for processing or those sent to an 
address other than specified in the ADDRESSES section will be returned 
to the applicant.
    Applicants will be notified of grant awards in July 1994. The 
starting dates for projects will be specified in the program guidance.

FOR FURTHER INFORMATION CONTACT: Additional information regarding 
technical and program issues may be obtained from: Beth Roy, Division 
of Services for Children with Special Health Needs, Maternal and Child 
Health Bureau, Health Resources and Services Administration, room 18A-
19, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, 
Telephone (301) 443-9051. Requests for information concerning business 
management issues should be directed to: John Gallicchio, Grants 
Management Officer (GMO), Maternal and Child Health Bureau, at the 
address specified in the ADDRESSES section.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

    The Pediatric AIDS Demonstration Program was initiated in 1988. The 
program grew from 13 projects funded at $4.4 million to a total of 44 
projects funded at $20.8 in 1993. Since 1988, the program has evolved 
from a primary focus on the coordination of services for the management 
and care of infected children and their families to also address the 
broader prevention and care needs of youth and women affected by the 
HIV infection, AIDS or related conditions. In FY 1994, Congress funded 
the Pediatric AIDS Demonstration Program under Title IV of the Ryan 
White Comprehensive AIDS Resources Emergency (CARE) Act (Title IV). The 
program will be permanently authorized in section 2671 of the Public 
Health Service Act. Title IV authorizes demonstration grants to 
organizations to provide comprehensive services and enhance access to 
clinical research trials for children, youth, women, and families with 
or affected by HIV infection. As a result of this transfer to Title IV, 
the focus of the program is further expanded to develop innovative 
models that link systems of comprehensive primary/community-based 
medical and social services for the affected population with NIH and 
other clinical research trials.

Purpose

    The purpose of the funding is to improve and expand the system of 
comprehensive care services for children, youth, women, and families 
who are infected with or affected by HIV and AIDS and to link 
comprehensive care systems with clinical research. Funds authorized and 
appropriated under Title IV will be used to demonstrate and test 
potentially replicable models of service delivery and clinical research 
to respond to the unique and challenging problems of access to a 
comprehensive care system faced by HIV and AIDS affected children, 
youth, women, and families.
    While children, youth, and women represent the most rapidly growing 
population groups affected by HIV and AIDS, they also represent the 
groups facing the greatest barriers in accessing care and research. 
These groups disproportionately are minorities and living in poverty. 
Children, youth, and women have a complex array of economic and social 
problems that increase their need for comprehensive services and 
increase the cost and intensity of care. Furthermore, since they 
comprise the most recent and fastest growing population groups impacted 
by HIV and AIDS, the care infrastructure and provider capacity are 
often not developed and require targeted resources and efforts to 
develop an appropriate system of care.
    Given these unmet needs, activities under the demonstration grants 
should address the following goals:

--Foster the development of comprehensive care infrastructures, 
including primary care, that increase access to culturally-competent, 
family-centered, community-based, coordinated care.
--Emphasize prevention within the comprehensive care system in order to 
reduce the spread of the HIV infection to vulnerable populations.
--Link comprehensive systems of care with HIV/AIDS clinical research 
trials resulting in increased access for currently under represented 
populations of children, youth, women, and their families.

Funding Categories

    Two categories of projects will be funded in FY 1994. Applications 
which do not fall within these program categories will not be 
considered.
    The first category of grants, the HIV Demonstration Projects for 
Children, Adolescents, and Families, continues development of 
comprehensive care demonstrations, including efforts to develop 
innovative models that foster collaboration between clinical research 
institutions and family-centered primary/community-based medical and 
social service programs for children, youth, women and their families. 
Projects will focus on local capacity-building, making maximum use of 
all available public and private resources for reaching and providing 
health care and supportive services to the target population. Projects 
should strengthen the infrastructure for the comprehensive system of 
care by broadening the coalition of agencies, providers, community 
organizations and families participating in services planning, 
coordination, and financing. These include other appropriate Federal, 
State, and local programs serving children with special health care 
needs under Title V Maternal and Child Health programs, hemophilia 
treatment centers, Ryan White Title I, II and III programs, providers 
funded by the Substance Abuse and Mental Health Services Administration 
(SAMSHA) and Centers for Disease Control and Prevention (CDC), and 
other programs serving the target population (e.g., Medicaid, 
developmental disabilities, special education) and providers, payers, 
organizations, and support groups in the private sector with a similar 
focus.
    Preference for funding in this category will be given to the 
competing renewal of currently funded Pediatric/Family AIDS 
Demonstration projects serving children, youth, women, and families 
infected with or affected by the HIV infection which demonstrate an 
established model of a comprehensive and coordinated system of care 
that is culturally-competent, family-centered, and community-based. 
This means that these projects will be funded ahead of new groups of 
applications in this category.
    The second category of funding will be used to initiate the 
development of comprehensive care systems for HIV affected children, 
adolescents and families in cities or states where there is no 
currently funded pediatric health care demonstration project nor well 
organized care system for the target population and where there are 
barriers to access to care and clinical research trials. Applicants for 
funding in this category will be supported for initial planning 
activities to develop their infrastructure for comprehensive care with 
the ultimate goal of a mature demonstration of family-centered, 
community-based coordinated care described in Category (1).

Availability of Funds

    Approximately $22.0 million is available for the HIV Demonstration 
Program for Children, Adolescents, and Families, of which approximately 
$10.3 million will be available for competing renewals and new 
competitive grants. The following is an approximation of funds 
available and the number of grants anticipated to be awarded in each 
category:

--Category (1)--$10.0 million, up to 20 grants.
--Category (2)--$.3 million, up to 4 grants. Individual grants are not 
expected to exceed $75,000 per year.

    For Category (1), project periods are three years. For Category 
(2), project periods are from one to two years, depending upon the 
proposed scope of work.

Special Concerns

    HIV Demonstration Program for Children, Adolescents, and Families 
grantees supported by HRSA should coordinate their projects with other 
Federal, State, and local programs concerned with AIDS and/or serving 
the target population of children, youth, women and families affected 
by or at risk for HIV/AIDS, particularly Title V Maternal and Child 
Health programs and other Ryan White programs.
    The MCHB places special emphasis on improving service delivery to 
women and children from culturally identifiable populations who have 
been disproportionately affected by barriers to accessible care. This 
means that projects are expected to serve and appropriately involve in 
project activities members of ethnoculturally distinct groups, unless 
there are compelling programmatic or other justifications for not doing 
so. The Bureau's intent is to ensure that project interventions and 
outcomes are of benefit to culturally distinct populations and to 
insure that the broadest possible representation of culturally distinct 
and historically under-represented groups is supported through programs 
and projects sponsored by the MCHB.
    The Department will review applications for funds under the above 
mentioned categories as competing applications and, with particular 
attention to inclusion of women and persons from culturally distinct 
populations, will fund those which, in the Department's view, best meet 
the statutory purposes of the HIV Demonstration Program for Children, 
Adolescents, and Families and address achievement of the Healthy People 
2000 objectives related to HIV infection.

Review Criteria

    Applications for grant categories will be reviewed and rated by 
objective review panels using the review criteria specified below, as 
appropriate. Please note that there are different criteria for Category 
(1) and Category (2) applicants.
     For Category (1) HIV Demonstration Projects:

--Adequacy of documentation of the impact of HIV/AIDS on children, 
youth, women, and families in the service area including: 
identification of HIV risk factors, description of trends in the HIV 
epidemic, and determination and documentation of unmet service needs.
--Ability to demonstrate an organized comprehensive system of family-
centered, community-based, coordinated care, including the following 
features: (1) Collaboration/coordination with appropriate community 
agencies and providers, particularly State Title V agencies, other Ryan 
White programs, and Healthy Start agencies (2) linkages to primary 
care, and (3) appropriate referral mechanisms.
--Adequacy of efforts to develop linkages with clinical trials and 
activities undertaken to facilitate access of the target population to 
trials, or identification of proposed activities to overcome barriers.
--Clarity of delineation of goals and objectives for the grant period 
and appropriateness of the timeline for proposed activities. 
Consistency of the plan with the goals of Title IV and the extent to 
which the plan addresses the needs identified in the needs assessment.
--Adequacy of the strategy and proposed steps to utilize and report 
data and evaluation for program planning and management, as well as for 
measuring the efficacy and effectiveness of the program.
--Organizational structure, staffing, and oversight necessary to 
implement the proposed goals and objectives.
--Adequacy of the proposed budget; budget justification based on 
project methodology and required resources.
--Evidence of ability to obtain funding from other public and private 
funding sources or indication of problems in accessing such funds.
--For competing renewal applicants only, demonstration of an organized, 
comprehensive system of care and progress in meeting the goals of the 
current project period will be assessed.

     For Category (2) Comprehensive Care Initial Development 
Grants:

--Adequacy of the description of the impact of HIV/AIDS on children, 
youth, women, and families in the service area including: 
identification of HIV risk factors, and description of trends in the 
HIV epidemic.
--Adequacy of the planned approach to conducting a needs assessment to 
identify existing resources to serve the target population and to 
determine and document unmet service needs.
--Evidence of knowledge and understanding of HIV service delivery and 
experience in providing services to the population to be served.
--Evidence of understanding of methods for developing comprehensive 
care linkages with clinical trials in order to increase access to 
trials for the target population.
--Evidence of the potential to collaborate with appropriate State/
community agencies and providers in planning and developing an 
organized, comprehensive system of family-centered, community-based, 
coordinated care.
--Clear delineation of goals and objectives with a timeline for 
accomplishment of proposed activities.
--Clarity and appropriateness of budget based on project methodology 
and required resources.
--Adequacy of the proposed data and evaluation plan.

Eligible Applicants

    Grants may be awarded to public or nonprofit private entities that 
provide or arrange for primary health care. Eligible entities may 
include, but are not limited to, State or local health departments, 
university medical centers, public or nonprofit private hospitals, 
community health centers (as defined in section 330(a) of the Act), 
hemophilia treatment centers, drug abuse treatment agencies, tribal 
health programs, school based clinics and institutions of higher 
education. All currently funded pediatric AIDS demonstration grantees 
are eligible for grant funds.

Allowable Costs

    The MCHB may support reasonable and necessary costs of HIV 
Demonstration Project grants within the scope of approved projects. 
Allowable costs may include salaries, equipment and supplies, travel, 
contractual, consultants, and others, as well as indirect costs. The 
MCHB adheres to administrative standards reflected in the Code of 
Federal Regulation 45 CFR part 92 and 45 CFR part 74. All other sources 
of funding to support this project must be accurately reflected in the 
applicant's budget.

Reporting Requirements

    A successful applicant under this notice will submit reports in 
accordance with the provisions of the general regulations which apply 
under 45 CFR part 74, subpart J, Monitoring and Reporting of Program 
Performance, with the exception of State and local governments to which 
45 CFR part 92, subpart C reporting requirements will apply. Financial 
reporting will be required in accordance with 45 CFR part 74, subpart 
H, with the exception of State and local governments, to which 45 CFR 
92.20 will apply.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements (approved under OMB No. 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 5161).
    (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.

Executive Order 12372

    The HIV Demonstration Program for Children, Adolescents, and 
Families 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 (Form PHS 
5161-1 with revised face sheet HHS Form 424 and with Program Narrative 
and Checklist approved under OMB 0937-0189) will contain a listing of 
States which have chosen to set up such a review system and will 
provide a single point of contact (SPOC) in the States for review. 
Applicants (other than federally-recognized Indian tribal governments) 
should contact their State 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 for new and competing awards. The granting agency 
does not guarantee to ``accommodate or explain'' State process 
recommendations it receives after that date. (See part 148, 
Intergovernmental Review of PHS Programs under Executive Order 12372 
and 45 CFR part 100 for a description of the review process and 
requirements.)

(The OMB Catalog of Federal Domestic Assistance number for the HIV 
Demonstration Program for Children, Adolescents, and Families is 
93.153.)

    Dated: December 16, 1993
John H. Kelso,
Acting Administrator.
[FR Doc. 94-1886 Filed 1-27-94; 8:45 am]
BILLING CODE 4160-15-P