[Federal Register Volume 59, Number 28 (Thursday, February 10, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-3009]


[[Page Unknown]]

[Federal Register: February 10, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service

 

Tribal Management Program for American Indians/Alaska Natives: 
Grants Application Announcement

AGENCY: Indian Health Service, HHS.

ACTION: Notice of competitive grant applications for tribal management 
grants for American Indians/Alaska Natives.

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SUMMARY: The Indian Health Service (IHS) announces that competitive 
grant applications are now being accepted for Tribal Management Grants 
for American Indians/Alaska Natives. These grants are established under 
the authority of section 103(b)(2) and section 103(e) of the Indian 
Self-Determination and Education Assistance Act, Pub. L. 93-638, as 
amended by Pub. L. 100-472, 25 U.S.C. 450h(b)(2). There will be only 
one funding cycle during fiscal year (FY) 1994. This program is 
described at 93.228 in the Catalog of Federal Domestic Assistance. 
These grants will be awarded and administered in accordance with this 
announcement; Department of Health and Human Services regulations 
governing Pub. L. 93-638 grants at 42 CFR 36.101 et seq. and 45 CFR 
part 92, Department of Health and Human Services, Uniform 
Administrative Requirements for Grants and Cooperative Agreements to 
State and Local Governments, or 45 CFR part 74, Administration of 
Grants to Non-profit Recipients; the Public Health Service Grant Policy 
Statement; and applicable Office of Management and Budget Circulars. 
Executive Order 12372 requiring intergovernmental review is not 
applicable to this program. Therefore, this program is not subject to 
the Public Health System Reporting requirements as referenced in 
Executive Order 12372. Public Health Service urges applicants 
submitting feasibility studies or health plans to address specific 
objectives of Healthy People 2000. Such interested applicants may 
obtain a copy of 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).

DATES: A. Application Receipt Date--An original and two (2) copies of 
the completed grant application must be submitted with all required 
documentation to the Grants Management Branch, Division of Acquisition 
and Grants Operations, Twinbrook Building, suite 300, 12300 Twinbrook 
Parkway, Rockville, Maryland 20852, by close of business March 28, 
1994.
    Applications shall be considered as meeting the deadline if they 
are either: (1) Received on or before the deadline with hand carried 
applications received by close of business 5 p.m. or (2) postmarked on 
or before the deadline and received in time to be reviewed along with 
all other timely applications. A legibly dated receipt from a 
commercial carrier or the U.S. Postal Service will be accepted in lieu 
of a postmark. Private metered postmarks will not be accepted as proof 
of timely mailing. Late applications not accepted for processing will 
be returned to the applicant and will not be considered for funding.
    B. Additional Dates:

1. Application Review: April 25, 1994
2. Applicants Notified of Results: On or about June 17, 1994 (approved, 
recommended for approval but not funded, or disapproved)
3. Anticipated Start Date: August 1, 1994.

CONTACTS FOR ASSISTANCE: For Tribal Management Grant program 
information, contact Ms. Bea Bowman, Division of Community Services, 
Indian Health Service, Parklawn Building, room 6A-05, 5600 Fishers 
Lane, Rockville, Maryland 20857, (301) 443-6840. For grant application 
and business management information, contact Mrs. Kay Carpentier, 
Grants Management Branch, Indian Health Service, Twinbrook Building, 
suite 100, 12300 Twinbrook Parkway, Rockville, Maryland 20852, (301) 
443-5204. (The telephone numbers are not toll-free.)

SUPPLEMENTARY INFORMATION: This announcement provides information on 
the general program purpose, eligibility and documentation, funding 
priorities, project types, funds available, limitations, period of 
support and application procedures for FY 1994.

A. General Program Purpose

    The purpose of the Tribal Management Grant Program is to improve 
the management capacity of a tribal organization to enter into a 
contract under the Indian Self-Determination Act, Pub. L. 93-638. 
Tribal management grants assist tribes and tribal organizations in 
preparing to assume operation of all or part of an existing IHS direct 
operated health care program by enabling them to develop and maintain 
their management capabilities.
    In addition, tribal management grants are available to any tribal 
organization under the authority of Public Law 93-638 section 103(e) 
for (1) obtaining technical assistance from providers designated by the 
tribal organization, including tribal organizations that operate mature 
contracts, for the purpose of program planning and evaluation, 
including the development of any management systems necessary for 
contract management, and the development of cost allocation plans for 
indirect cost rates; and (2) planning, designing, and evaluating 
Federal health programs serving the tribe, including Federal 
administrative functions.
    Tribal management grants may not be used to support operational 
programs, or to supplement existing public and private resources. The 
grants may, however, be used as matching shares for other Federal grant 
programs that develop tribal capabilities to contract for the 
administration and operation of health programs.

    Note: Projects related to water, sanitation, waste management; 
and long term care; tuition, fees, stipends for certification and 
training of staff providing direct services; and design and planning 
of construction for facilities will not be considered eligible for 
review. Projects which include training and technical assistance on 
the pending regulations for Indian Self-Determination and Education 
Assistance Act, Pub. L. 93-638, as amended by Pub. L. 100-472, will 
not be considered for funding. Inclusion of these activities in a 
proposed project shall render the application ineligible and the 
application will be returned to the applicant.

B. Eligibility and Documentation

    Any federally recognized Indian tribe or Indian tribal organization 
is eligible to apply for a grant, however, only one tribal management 
grant will be awarded and funded to a tribe or tribal organization per 
funding cycle. Eligible applicants include tribal organizations that 
operate mature contracts who are designated by a tribe or tribes to 
provide technical assistance and/or training.
    The following documentation is required:
    1. Documentation of new federally recognized/restored tribes--A 
copy of the Federal Register Notice of letter from the Bureau of Indian 
Affairs (BIA) verifying tribal status.
    2. Tribal Resolution--(a) A resolution of the Indian tribe(s) 
served by the project must accompany the application; (b) Applications 
which propose projects to include more than one Indian tribe must 
include resolutions from all tribes to be served; and (c) Applications 
by tribal organizations will not require a specific tribal 
resolution(s) if the current blanket tribal resolution(s) under which 
they operate would encompass the proposed grant activities.

C. Funding Priorities

    The IHS has established the following funding priorities for 
awarding tribal management grants. Funding priorities were published 
for public comment in the Federal Register on November 23, 1992, at 57 
FR 54986 and retained with clarification as published on March 12, 1993 
at 58 FR 13605.

Priority I

    An Indian tribe that has received Federal recognition (new, 
restored, unterminated, funded or unfunded) within the past three (3) 
years and is preparing to contract under Pub. L. 93-638 to assume 
operation of health care services.

Priority II

    An Indian tribe or Indian tribal organization currently contracting 
with IHS, with a stated intention to contract all or part of an 
existing IHS operated service unit or health program. Applicants 
meeting this profile must have current certified management systems, 
i.e. BIA, IHS, or CPA certified; and resolutions of support from the 
tribes to be served by the project in a multi-tribal service unit.

Priority III

    An Indian tribe or Indian tribal organization stating an interest 
in contracting IHS health programs for the first time. Applicants 
meeting this profile must have current certified management systems, 
i.e. BIA, IHS, or CPA certified; or respond within a specific time 
period in the first quarter of the grant period to establish certified 
management systems to begin receiving federal funds.

Priority IV

    An Indian tribe or Indian tribal organization stating an interest 
in planning, designing and evaluating Federal health programs serving 
the tribe, including Federal administrative functions.

Priority V

    An Indian tribe or Indian tribal organization currently contracting 
IHS tribal programs, i.e., Community Health Representative program, 
Alcohol programs, Emergency Medical Services, etc., and are seeking 
improvement or expansion of existing tribal health management structure 
without further contracting.

D. Project Types

    The Tribal Management Grant Program consists of seven (7) types of 
projects: (1) Feasibility studies, (2) planning, (3) development of 
tribal health management structure, (4) human resources development, 
(5) evaluation, (6) technical assistance and (7) Federal programs 
analysis.

    Note: The above listing of project types are not subject to 
prioritization.

    Applications shall address only one project type as opposed to a 
combination of two or more project types.

Project Types Descriptions

    1. Feasibility Study--a study of a specific IHS program or segment 
of a program to determine if tribal management of the program is 
possible. This study shall indicate necessary plans, approach, training 
and resources required to assume tribal management of the program. The 
study shall include a minimum of four (4) major components:
    a. Health needs and health care services assessments, which 
identify existing health care services and delivery system, program 
division issues, health status indicators, unmet needs, volume 
projections, and demand analysis.
    b. Management analysis of existing management structure, proposed 
management structure, implementation plans and requirements, and 
personnel staffing requirements and recruitment barriers.
    c. Financial analysis of historical trends data, financial 
projections and new resource requirements for program and management 
costs, and analysis of potential revenues from Federal/Non-Federal 
sources.
    d. Decision stage which incorporates findings; conclusions and 
recommendations; and presentation of the feasibility study and 
recommendations to the governing body to determine whether tribal 
assumption of the health program(s) is desirable or warranted.
    2. Plan--a collection of data to establish goals, policies, and 
procedures for operation of tribal health programs. Health plans shall 
specify IHS health programs and the priority order in which the tribe 
will assume operation of these programs. A plan shall include a minimum 
of four components:
    a. Survey and analysis of the population's needs.
    b. Prioritization of health needs and programs.
    c. Statement of goals and objectives for each program to be 
assumed.
    d. Strategy including policies and procedures for tribal assumption 
and operation of each program.
    3. Development of Tribal Health Management Structure--creation or 
enhancement and implementation of systems to manage, organize or direct 
health programs. Management structures include health department 
structure and organization, tribal health boards, systems for 
accounting, personnel, third party billing, medical records, etc., 
upgrading to achieve accreditation through Joint Commission on 
Accreditation of Health Organizations (JCAHO) or development of fiscal 
and patient registration systems to meet requirements of Federally 
Qualified Health Centers (FQHC). Management structure projects shall 
include at minimum the following:
    a. Description of existing structures.
    b. Explanation of the purpose and design of the proposed management 
structure.
    c. Identification of improvements expected and impact of newly 
created or enhanced management structure proposed.
    d. Short range and long range strategies for tribal operation of 
the management structure.
    4. Human Resources Development--development of a particular skill 
or group of skills required for tribal staff to manage or operate an 
IHS program. The human resources development plan shall at minimum 
include:
    a. Training needs assessment and analysis of education, skills and 
experience of current staff and future requirements.
    b. Assessment of management and administrative competence required 
to meet short range (1-2 years) and long range (not more than 5 years) 
needs coupled with identification of organizational needs.
    c. Identification of short range and long range management training 
program.
    5. Evaluation Studies--a systematic collection, analysis, and 
interpretation of data to determine the value of current tribal health 
programs. Evaluation studies shall at minimum include:
    a. Effects of any previous studies as related to the goals and 
objectives, policies and procedures, or programs on target groups.
    b. A description of the current tribal health programs' 
effectiveness and efficiency, including direct services, financial 
management, personnel, data collection and analysis, third party 
billing, etc.
    c. Identification of what could be done to improve the health care 
delivery system(s).
    6. Technical Assistance--aid or help from providers designated by 
the tribal organization, including tribal organizations that operate 
mature contracts, for the purposes of program planning and evaluation, 
including development of any management systems necessary for contract 
management, and development of cost allocation plans for indirect cost 
rates. For example, an Indian tribe or Indian organization may wish to 
seek technical assistance from a tribe to develop a managed care 
component for a direct service delivery system.
    7. Federal Programs Analysis--projects focused on planning, 
designing and evaluating Federal programs serving the tribe, including 
Federal administrative functions. For example a tribe or tribal 
organization may wish to evaluate IHS direct services programs such as 
Contract Health Services, Mental Health, Public Health Nursing, etc.

E. Funds Available, Limitations and Period of Support

    1. Funds available--It is anticipated that approximately $5,000,000 
will be available for approximately 75 new and continuation grants 
averaging $67,000 each. Grant funding levels include both direct and 
indirect costs.
    2. Limitations--Only one grant project will be awarded per tribe or 
tribal organization. A current tribal management grantee whose project 
will not be completed within the current grant period will not be 
awarded new, renewal or competing continuation grants.
    3. Period of support--(a) feasibility studies and planning projects 
are limited to one year (12 months) funding; (b) projects regarding 
tribal management structure, human resources development, evaluation, 
technical assistance, and Federal programs analysis may be funded up to 
three (3) years in annual budget periods depending upon the defined 
scope of work.

F. The Tribal Management Grant Application Kit

    A Tribal Management Application Kit, including the required PHS 
form and Narrative PHS 5161-1 (Rev. 7/92) (OMB Approval No. 0937-0189) 
and the U.S. Government Standard forms (SF-424, SF-424A and SF-424B), 
may be obtained from the Grants Management Branch, Division of 
Acquisition and Grants Operations, IHS, Twinbrook Metro Plaza, suite 
100, 12300 Twinbrook Parkway, Rockville, MD 20852, telephone (301) 443-
5204. (Note: This is not a toll free number.)

G. Grant Application Requirements

    All applications must be singled-spaced, typewritten, and 
consecutively numbered pages using black type not smaller than 12 
characters per one inch, with conventional border margins, on only one 
side of standard size 8\1\/\2\  x  11 paper that can be photocopied. 
All applications must include the following in the order presented:

--Tribal Resolution(s) and Documentation (B. Eligibility and 
Documentation),
--Standard Form 424, Application for Federal Assistance,
--Standard Form 424A, Budget Information--Non-Construction Programs, 
(pages 1 and 2),
--Standard form 424B, Assurances--Non-Construction Programs (front and 
back),
--Checklist (pages 23-24) Note: Each standard form and the checklist is 
contained in the PHS Grant Application, Form PHS 5161-1 (Revised 7/92),
--A one-page project abstract (H. 1.),
--A table of contents (H. 2.),
--Introduction (H. 3.),
--Need for Assistance (H. 4.),
--Objective(s), Results, and Benefits Expected (H. 5),
--Approach (H. 6.),
--Evaluation (H. 7),
--Key Personnel (H. 8.),
--Budget Justification and Management Controls (H. 9), and
--Appendix to include:
*Resumes (Curriculum Vitae) of key staff,
*Position descriptions for key staff,
*Organizational chart,
*Copy of current negotiated indirect cost rate agreement,
*A map of the area to benefit from the project,
*A copy of the survey instrument, if used.
*Application Receipt Card, PHS--3038-1 Rev. 5-90.

H. Application Narrative Instructions, Application Standards (Criteria) 
and Weights

    The following instructions for preparing the application narrative 
also constitute the standards (criteria or basis for evalaution) for 
reviewing the application to approve or disapprove. Weights assigned 
each section are noted in parenthesis.
    1. Abstract--An abstract may not exceed one typewritten page. The 
abstract should clearly present the application in summary form, from a 
``who-what-when-where-how-cost'' point of view so that reviewers see 
how the multiple parts of the application fit together to form a 
coherent whole.
    2. Table of Contents--Provide a one page typewritten table of 
contents.
    Narrative: Please describe the complete project in clear and 
succinct language as application reviewers may have little or no 
knowledge regarding the tribe or tribal organization. It should be 
organized as described in this section, should not exceed 25 single 
spaced pages, and address the following: (Note: Application narratives 
exceeding 25 pages will not be accepted for review.)
    3. Introduction (5 pts.)
    a. Identify the funding priority and justify the priority selected.
    b. Identify the type of project.
    c. State the type (specific or blanket) and date of resolution 
submitted with the application. (Refer to B. Eligibility and 
Documentation).
    d. Describe the population to be served by management of tribal 
health programs and the number of eligible beneficiaries.
    e. Provide a precise location of the project and area to be served 
by the proposed project including a map (include the map in the 
appendix).
    4. Need for Assistance (10 pts.)
    a. Explain the reason for the project.
    b. Describe the tribe's current health operations including whether 
the tribe has a health department, how long it has been operating, what 
programs or services are currently provided and indicate 
accomplishments using statistics if available.
    c. Describe the overall and specific need for assistance by 
explaining the current and past situation or demand and unmet need 
(i.e., resources, staffing, equipment, training, etc.).
    d. Identify relevant environmental, economic, social, financial or 
organizational programs requiring solutions.
    e. Include relevant statistical data to support the need and 
include examples.
    f. Describe the relationship between this project and other 
federally funded work planned, anticipated, or underway.
    g. Identify all previous and/or current tribal management grants 
received, dates of funding, and project accomplishments (Do not include 
copies of reports).
    5. Objective(s) Results and Benefits Expected (20 pts.)
    a. State is measurable terms, realistic principal and subordinate 
objectives of the project.
    b. Identify the expected results, benefits and outcome or product 
to be derived from each objective of the project.
    c. Identify who will do what, when, and how, relating to the 
anticipated outcome of the project.
    6. Approach (20 pts.)
    a. Outline and describe the major tasks and activities with the 
objective(s) to be achieved.
    b. Include a workplan with start, target milestones and completion 
dates on a calendar timeline.
    c. Discuss present or proposed staffing of the project. Position 
descriptions for key personnel must be included in the Appendix.
    d. Describe data sources, management, quality control, and analysis 
by addressing:
    1. Data to be collected, by whom, and time intervals in the 
project,
    2. Data sources and how access to the sources will be attained,
    3. Procedure to collect, receive, code and prepare the data for 
analysis,
    4. How data will be kept confidential and secure,
    5. Contingency plan for low response rates,
    6. How completeness and accuracy of data will be measured and 
assured.
    7. Plan for statistical or non-statistical analyses of data,
    8. Include a copy of survey instrument(s), if used.
    e. If use of consultants or contractors is proposed or anticipated, 
provide a detailed scope of work which clearly defines the deliverable 
or outcomes anticipated; and qualifications and experience 
requirements.
    f. Identify who will review and accept the work products of the 
project deliverable/outcomes, including work to be performed by 
consultants or contractors.
    7. Evaluation (15 pts.)
    a. State how it will be determined if the project's objectives were 
achieved and how the accomplishment of those objectives can be 
attributed to the project.
    b. Discuss the criteria to be used to evaluate results and 
benefits.
    c. Explain the methodology that will be used to determine if the 
needs identified for the project are being met and if the project's 
outcomes identified are being achieved.
    8. Key Personnel (15 pts.)
    a. Provide job position descriptions and resumes (if applicable) 
for key staff.
    b. Identify qualifications and experience requirements for 
consultants or contractors if use is anticipated.
    c. State the tribe's approved Indian Preference policy.
    9. Budget Justification and Management Control (15 pts.)
    a. Provide a budget justification in accordance with the budget 
narrative instructions contained on page 21 of form PHS 5161-1
    b. Describe where the project will be housed, i.e., facilities and 
equipment available.
    c. List equipment and software purchases necessary for 
implementation of the project; include descriptive rationale and 
justification for computer hardware/software.
    d. Describe the management control of the tribe/tribal organization 
over the direction and acceptability of work to be performed by the 
consultant or contractor.
    e. Provide documentation of current certified financial management 
system, i.e. BIA, IHS, or CPA certified.
    f. If a first-time applicant, include a plan to meet the special 
requirement of establishing certified management systems to begin 
receiving Federal funds.
    g. If indirect cost are claimed, applicant must submit a copy of 
Indirect Cost Rate Agreement supporting this claim.
    10. Multi-year Projects--projects requiring a second or third year 
must include a program narrative and categorical budget and 
justification for each additional year of funding requested.
    11. Appendix--to include:
    a. Current approved organizational chart,
    b. Resumes and job descriptions for key staff,
    c. Copy of current negotiated indirect cost rate agreement,
    d. A map of the area to benefit from the project,
    e. A copy of the survey instrument, if used, and
    f. Application receipt card, PHS 3038-1 Rev. 5-90.

I. Assurances

    The application shall contain assurances to the Secretary that the 
applicant will comply with program regulations, 42 CFR part 36 subpart 
H.

J. Reporting

    1. Program Report--Program progress reports will be submitted 
quarterly. These reports will include a brief description of a 
comparison of actual accomplishments to the goals established for the 
period, reasons for slippage and other pertinent information as 
required. A final report is due 90 days after expiration of the budget/
project period.
    2. Financial Status Report--Quarterly financial status reports will 
be submitted 30 days after the end of the quarter. Final financial 
status reports are due 90 days after expiration of the budget/project 
period. Standard Form 269 (long form) will be used for financial 
reporting.

K. Grant Administration Requirements

    Grants are administered in accordance with the following documents:
    1. 45 CFR part 92, Department of Health and Human Services, Uniform 
Administrative Requirements for Grants and Cooperative Agreements to 
State and Local Governments, or 45 CFR part 74, Administration of 
Grants to Non-profit recipients.
    2. Public Health Service Grant Policy Statement, and
    3. Appropriate Cost principles: OMB Circular A-87, State and Local 
Governments, or OMB Circular A-122, Non-profit Organizations.

L. Objective Review Process

    Applications meeting eligibility requirements that are complete and 
conform to this program announcement will be reviewed by a centralized 
Ad Hoc Objective Review Committee (ORC) appointed by IHS primarily for 
review of these applications. The review will be conducted at the IHS 
Headquarters and in accordance with IHS objective review procedures. 
The objective review process ensures nationwide competition for limited 
funding. The ORC will be comprised of IHS (40% or less) and other 
federal or non-federal individuals (60% or more) with appropriate 
expertise. The ORC will review each application against established 
criteria. Based upon the evaluation criteria, the reviewers assign a 
numerical score to each application, which will be used in making the 
final funding decision. Applications scoring less than 60 points will 
be considered technically unacceptable and will be disapproved.

M. Application Standards Qualitative Rating Factors

    1.0=Excellent--very comprehensive, in-depth clear response. The 
application meets this standard with no omissions. Consistently high 
performance can be expected.
    0.8=Very Good--extensive, detailed application similar to excellent 
in quality, but with minor areas requiring additional clarification. 
High quality performance is likely, but not assured due to minor 
omissions or areas where less than excellent performance might be 
expected.
    0.6=Good--no deficiencies in the response. Better than acceptable 
performance can be expected, but in some significant area there is lack 
of clarity which might impact on performance.
    0.4=Fair--the response generally meets minimum standards. Existing 
deficiencies are confined to areas with minor impact on performance and 
can be corrected without revision.
    0.2=Marginal--deficiencies exist in significant areas. The 
application can be corrected without major revision or serious 
deficiencies exist in areas with minor impact.
    0.0=Unsatisfactory--serious deficiencies exist in significant 
areas. The project cannot be expected to meet minimum requirements 
without revisions. The application only indicates a willingness to 
perform a project without specifying how or demonstrating the capacity 
to do so. Only vague indications exist regarding capability.

N. Results of the Review

    The results of the objective Review are forwarded to the Associate 
Director, Office of Tribal Activities, for final review and approval. 
Applicants are notified of their approval or approval without funds, on 
or about June 17, 1994. A Notice of Grant Award will be issued 
approximately ten (10) days prior to the start date of August 1, 1994. 
Unsuccessful applicants are notified in writing of disapproval not 
later than June 17, 1994. A brief explanation of the reasons the 
application was not approved is provided along with the name of an IHS 
official to contact if more information is desired.

    Dated: December 10, 1993.
Michel E. Lincoln,
Acting Director.
[FR Doc. 94-3009 Filed 2-9-94; 8:45 am]
BILLING CODE 4160-16-M