[Federal Register Volume 59, Number 49 (Monday, March 14, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-5790]


[[Page Unknown]]

[Federal Register: March 14, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
[RIN-0905-ZA06, PN 2179]

 

Availability of Funds for Community and Migrant Health Center 
Activities

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces the availability of discretionary funds of approximately 
$617.5 million in fiscal year (FY) 1994 for Community and Migrant 
Health Center (C/MHC) activities including grants for the operation of 
C/MHCs, the Comprehensive Perinatal Care Program (CPCP) and Special 
Infant Mortality Reduction Initiative (SIMRI), and capital 
improvements.
    A subsequent notice will be issued in the Federal Register to 
announce the availability of approximately $17 million to support new 
start and expansion grants for C/MHCs, a minimal number of planning 
grants for future CHCs and grants for the development and/or expansion 
of networking activities of C/MHCs.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS-led national activity for setting priority areas. The 
health center program directly addresses the Healthy People 2000 
objectives by improving access to preventive and primary care services 
for underserved populations, especially minority and other 
disadvantaged populations. Potential applicants may obtain a copy of 
Healthy People 2000 (Full Report; Stock No. 017-001-00474-01) or 
Healthy People 2000 (Summary Report; Stock No. 017-001-00473-01) 
through the Superintendent of Documents, Government Printing Office, 
Washington, DC 20402-9325 (Telephone 202-783-3238).

APPLICATION DEADLINES: Applications shall be considered to have met the 
deadline if they are: (1) Received on or before the deadline; or (2) 
sent on or before the established 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. Private 
metered postmarks shall not be accepted as proof of timely mailing.) 
Late applications not accepted for processing will be returned to the 
applicant. Deadlines are as follows:

SECTIONS 329 AND 330 FUNDS: Competing continuation applications for 
section 329 and/or Section 330 funds to provide essential services are 
due 120 days prior to the expiration of the current project period 
award unless otherwise specified. Non-competing continuation 
applications are due 120 days prior to the expiration of the current 
budget period.

CAPITAL: In order to be considered for funding, major capital 
applications must be received no later than April 13, 1994. Minor 
capital improvements will continue to be included in a project's 
section 329 or section 330 continuation application. Emergency 
supplemental requests (major or minor) may be submitted at any time 
during the year.

ADDRESSES: The PHS Regional Grants Management Officers (RGMOs), whose 
names and addresses are provided in the appendix to this document, are 
responsible for distributing application kits and guidance (PHS form 
5161-1 with revised face sheets DHHS Form 424, as approved by the 
Office of Management and Budget (OMB) under control numbers 0937--
0189). Completed applications must be submitted to them. The kits and 
guidance will be sent to existing grantees, while new applicants should 
contact the appropriate RGMO. The RGMOs are available to provide 
assistance on business management issues.

FOR FURTHER INFORMATION CONTACT: For general program information about 
the availability of sections 329, 330, 329(g)(1), 330(f)(1) and 333(d) 
funds, contact Richard C. Bohrer, (301) 594-4300. For additional 
information about funding under section 329, contact Antonio Duran, 
(301) 594-4303. Additional information about CPCP and SIMRI can be 
obtained from Joan Holloway, (301) 594-4420.

SUPPLEMENTARY INFORMATION:

A. General Primary Care Services Delivery

Grant Amounts

    It is estimated that approximately $521 million in discretionary 
continuation grants for CHC activities (i.e., approximately $478 
million for general primary care services delivery and $43 million for 
CPCP and SIMRI activities) and approximately $59 million in 
discretionary grants for continuation of MHC activities (i.e., 
approximately $57 million for general primary care services delivery 
and $2 million for CPCP and SIMRI activities) will be available under 
sections 330 and 329 of the Public Health Service (PHS) Act (42 U.S.C. 
254c and 254b, respectively). Of the total $45 million available for 
CPCP and SIMRI activities, approximately $10 million will be for SIMRI.
    In addition, approximately $16 million will be available for 
existing C/MHCs to support the increased cost of providing services to 
their current patients. Within the $16 million, approximately $10 
million will be available for current service adjustments, including 
support for the recruitment and retention of health care providers in 
C/MHCs, service education linkages with academic institutions, school-
based or school-linked programs, and activities to address high 
prevalence morbidity and mortality (e.g., HIV/AIDS). Current service 
adjustments, where applicable, enable C/MHCs to show the need for 
additional funds to maintain the existing range of services for the 
current number of patients when existing levels of service cannot be 
supported with the total Federal and non-Federal revenue. The remaining 
$6 million will be used for C/MHC improvement proposals to enhance the 
provision of required services. Such improvement proposals should be 
presented in priority order. The improvement proposals for which 
funding may be made available include the following required services: 
dental, pharmacy, culturally sensitive/ translation services, and case 
management.

Number of Awards

    A total of approximately 600 C/MHC grants will be made available, 
of which approximately 223 ($216 million) will be for competing 
continuation grants and approximately 377 ($364 million) will be for 
non-competing continuation grants. Approximately 300 of these grants 
will include CPCP and SIMRI activities. Grants will range from 
approximately $200,000 to approximately $2 million for general primary 
care services delivery (C/MHC). Grants will range from approximately 
$24,000 to approximately $450,000 for CPCP and SIMRI activities in C/
MHCs. Awards will be made for a one year budget period. SIMRI grantees 
will continue to have budget periods beginning September 30 for FY 
1994. Project periods will be for up to three years. Requests for 
current service adjustments and improvement proposals will be included 
in the continuation grant application.

Eligible Applicants

    It is the intent of HRSA to continue to support health services in 
the service areas of currently funded C/MHCs, given the unmet need 
inherent in their designation as medically underserved. Within their 
project periods, only present grantees may apply for sections 329 and 
330 awards to continue to provide health services in medically 
underserved areas. However, any nonprofit private and public entities 
may apply to serve the geographic areas where project periods are 
expiring. For a list of service areas with expiring project periods, 
see Federal Register notice published on May 3, 1993, 58 FR 26328 et 
seq.

Review Criteria

    When determining whether Federal support will be made available for 
continuing awards, the Department will review C/MHCs for compliance 
with standard criteria stipulated in the program regulations (42 CFR 
part 51c for CHC and part 56 for MHC activities) and for how 
effectively they have used previously awarded sections 330 and 329 
funds. This year's reviews will continue to emphasize need and 
community impact, health services, management and finance, and 
governance. Specifically, applications will be evaluated based on: (1) 
The demonstrated need for services based on geographic, demographic, 
and economic factors, resources in the area, and health status; (2) the 
capacity to provide primary health services as appropriate to meet the 
needs of the community, as evidenced by such attributes as an adequate 
medical provider staff (e.g., number, specialty mix, and 
qualifications), critical linkages to other relevant entities (e.g., 
State or local health departments, State Medicaid agencies, health 
professions training programs), and coordination with other levels of 
care; (3) appropriate leadership, management structures and financial 
systems to enable delivery of health services efficiently and 
effectively; (4) appropriateness of governing board composition, 
committee structure, and performance to enable the board to function 
fully and effectively in its fiduciary role; and (5) how the applicant 
integrates services supported by this grant with health services 
provided under other federally assisted programs.

B. Capital Improvements

    Approximately $4.5 million will be available to support new major 
and minor capital improvements. Major capital requests are requests for 
Federal grant support in excess of $100,000 and will fall into one of 
two categories: (1) Proposals to correct major fire and life safety 
code violations; and (2) proposals to expand facilities to eliminate 
overcrowding associated with an increased demand for services. Major 
capital improvements include: facility acquisition, construction, 
alteration, renovation, expansion and modernization.
    Minor capital improvements are requests for Federal grant support 
of less than $100,000. Minor capital proposals submitted in 
continuation applications for FY 1994 should address the same 
categories of projects as those to be considered for major capital 
projects, i.e., to correct fire and life safety code violations and to 
relieve overcrowding.
    Emphasis will be given to capital proposals that correct existing 
fire and life safety code violations, particularly violations that 
disrupt the delivery of primary care services and may pose a danger to 
health center patients and staff. Fire and life safety code violations 
include those that are cited or clearly documented.

Review Criteria

    Applications for major capital will be reviewed against the 
following criteria: (1) Documented community need for continued service 
delivery; (2) extent of the facility need; (3) appropriateness of site 
selection; (4) availability of other sources of proposed financing; and 
(5) soundness of the proposal. Awards will be issued by September 30, 
1994, except for minor capital improvements which may be made sooner, 
depending on the nature of the building deficiency.

C. Comprehensive Perinatal Care Program and Special Infant Mortality 
Reduction Initiative

Eligible Applicants

    All CPCP and SIMRI awards are expected to be made as continuation 
awards to current recipients of CPCP and SIMRI funding which are 
performing satisfactorily.

Review Criteria

    The review criteria for CPCP continuations, including SIMRI, are: 
(1) The extent to which the current and proposed basic center 
operations are sound; (2) the extent to which infants born to the 
center's perinatal users are at high risk for mortality and/or 
morbidity; (3) the extent to which the previous CPCP funding has been 
used to enhance the basic perinatal services of the center, such as by 
provision of case management (risk assessment, coordination and 
referral, follow-up and tracking, crisis intervention and 
documentation), outreach to targeted special populations (e.g., 
homeless, HIV-infected, substance abusing, teenaged populations), 
patient education and counseling, and home visiting; (4) the capability 
of the center to improve perinatal health as demonstrated through 
various process and outcome measures of progress, such as increased 
perinatal caseload, increased first trimester enrollment, reduced late 
or absent entry into care, increased post partum return rate, reduced 
incidence of low birth weight, and increased newborn visits (an 
increase in perinatal caseload may also be a process indicator of 
progress in reaching out to women to get them into care early); (5) the 
extent to which the plan is reasonable in that it: (a) addresses the 
specific perinatal care needs of the community, focusing on women and 
infants at high risk of poor health status; (b) further develops an 
appropriate system of care which includes collaboration with other 
resources; (c) contains specific time-framed, measurable objectives, 
responsive to the CPCP and SIMRI expectations and the clinical 
measures; and (d) contains an associated budget which is appropriate 
for the proposal in that it is in accordance with Federal cost 
principles and corresponds to the proposed activities.
    Additional review criteria for SIMRI applicants include: (1) For 
those SIMRI grantees in Healthy Start target areas, the extent and 
effectiveness of collaborative efforts with the Healthy Start 
consortium; (2) the extent of collaborative efforts with other Federal, 
State and local programs to develop integrated systems of perinatal 
care that address the needs of the community; and (3) the extent to 
which the grantee's plan and progress demonstrate that SIMRI funds are 
being used to effectively address gaps in perinatal services throughout 
the community.

Other Award Information

    All grants to be awarded under this notice are subject to the 
provisions of Executive Order 12372, as implemented by 45 CFR part 100, 
which allows States the option of setting up a system for reviewing 
applications from within their States for assistance under certain 
Federal programs. The application kits will contain a listing of States 
which have chosen to set up such a review system and will provide a 
point of contact in the States for that review. Applicants (other than 
Federally recognized Indian Tribal governments) should contact their 
State Single Points of Contact (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. State process recommendations should be submitted to 
the appropriate Regional Office (see Appendix). The due date for State 
process recommendations is 60 days after the appropriate application 
deadline date. The Bureau of Primary Health Care does not guarantee 
that it will accommodate or explain its response to State process 
recommendations received after this date.

Public Health System Reporting Requirement

    Section 329 and section 330 programs are subject to the Public 
Health System Reporting Requirement, PHS Circular 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.
    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: (1) A copy of the face page of 
the application (SF 424); and (2) a summary of the project (PHSIS), not 
to exceed one page, which provides a description of the population to 
be served, a summary of the services to be provided and a description 
of the coordination planned with the appropriate State or local health 
agencies.

(In the OMB Catalog of Federal Domestic Assistance, the Community 
Health Center program is listed as Number 93.224 and the Migrant 
Health Center program is listed as Number 93.246.)

    Dated: January 18, 1994.
William A. Robinson,
Acting 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

Martin Bree, Acting Grants Management Officer, PHS Regional Office 
III, P.O. Box 13716, Philadelphia, PA 19101, (215) 596-6653

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 64016, (816) 426-
5841

Region VIII

Susan Jaworowski, Acting Grants Management Officer, PHS Regional 
Office VIII, 1961 Stout Street, Denver, CO 80294, (303) 844-4461

Region IX

Al Tevis, Acting 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) 553-7997
[FR Doc. 94-5790 Filed 3-11-94; 8:45 am]
BILLING CODE 4160-15-P