[Federal Register Volume 59, Number 53 (Friday, March 18, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6283]


[[Page Unknown]]

[Federal Register: March 18, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[RIN-0905-ZA07; PN#2178

 

Rural Telemedicine Grant Program

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

ACTION: Notice of availability of funds.

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SUMMARY: The Office of Rural Health Policy, HRSA, announces that 
applications are being accepted for Rural Telemedicine Grants to (1) 
develop a base of information for conducting a systematic evaluation of 
telemedicine systems serving rural areas; and (2) facilitate 
development of rural health care networks through the use of 
telemedicine. Awards will be made from funds appropriated under Public 
Law 103-112 (HHS Appropriation Act for FY 1994). Grants for these 
projects are authorized under section 301 of the Public Health Service 
Act.

National Health Objectives for the Year 2000

    The 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 Rural Telemedicine Grant 
program is related to the priority areas for health promotion, health 
protection, and preventive services. Potential applicants may obtain a 
copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-C) 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).

Funds Available

    Approximately $4.0 million is available for the Rural Telemedicine 
Grant program in FY 1994. With these funds, the Office of Rural Health 
Policy expects to make approximately eight awards for one year. 
Applicants may propose project periods for up to three years. However, 
applicants are advised that continued funding of grants beyond the one-
year period supported under this announcement is subject to 
appropriation of funds and assessment of grantee performance. The start 
date for the new projects will be September 30, 1994.

Funding Limits

    Individual grant awards under this notice will be limited to a 
total amount of $500,000 (direct and indirect costs) per year. 
Applications for smaller amounts are strongly encouraged. Equipment 
costs up to 40 percent of the total grant award are allowable. However, 
the costs of purchasing and installing transmission equipment, such as 
laying cable or telephone lines, microwave towers, digital switching 
equipment, amplifiers, etc., are not allowable. Transmission costs are 
allowable. Indirect costs are allowable up to 20 percent of the total 
grant award.
    Grant funds may not be used for construction, except for minor 
renovations related to the installation of equipment. Grant funds may 
not be used to acquire or build real property.

Cost Participation

    Cost participation serves as an indicator of community and 
institutional support for the project and of the likelihood that the 
project will continue after Federal grant support has ended. Applicants 
are required to demonstrate cost participation in the form of 
equipment, personnel, building space, indirect costs, other in-kind 
contributions, or cash.

DATES: Applications for the program must be received by the close of 
business on May 20, 1994.
    Applications shall be considered as meeting the deadline 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 must obtain a legible dated receipt from 
a commercial carrier or the U.S. Postal Service in lieu of a postmark. 
Private metered postmarks will not be acceptable as proof of timely 
mailing. Late applications will be returned to the sender.

ADDRESSES: Requests for grant application kits should be directed to 
Monte Parham, Office of Rural Health Policy, 301-443-0835. Requests for 
additional information regarding business or fiscal issues, and 
completed applications, should be directed to: Opal McCarthy, Grants 
Management Office, Bureau of Primary Health Care, West Tower, 11th 
floor, 4350 East West Highway, Rockville, MD 20857, (301) 594-4260. The 
standard application form and general instructions for completing 
applications (Form PHS-5161-1, OMB 0937-0189) have been approved by the 
Office of Management and Budget (OMB).

FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic 
information on this announcement should be directed to Carole Mintzer 
or Cathy Wasem, Office of Rural Health Policy, 5600 Fishers Lane, Room 
9-05, Rockville, MD 20857, (301) 443-0835.

SUPPLEMENTARY INFORMATION:

Program Objectives

    The purpose of the program is to demonstrate and collect 
information on the feasibility, costs, appropriateness, and 
acceptability (to practitioners and patients) of telemedicine for 
improving access to health services for rural residents and reducing 
the isolation of rural practitioners. Grants will be awarded for 
implementing and operating telemedicine systems that link multi-
specialty entities with rural health care facilities for the purposes 
of delivering health care services to the rural sites and exchanging 
information between the sites.
    A central goal of the program is to demonstrate how telemedicine 
can be used as an effective tool in the development of integrated 
systems of health care. Integrated systems of care provide 
comprehensive, coordinated health care services to the rural residents 
served by the system through referrals, consultations, and support 
systems that ensure patient access to a comprehensive set of services 
and reduce practitioner isolation. In particular, the program is to 
promote systems of health care in rural areas that link rural primary 
care practitioners with specialty and referral services.
    For the purposes of this grant program, telemedicine is defined as 
the use of telecommunications for medical diagnosis and patient care. A 
clinical consultation is defined as a person-to-person interaction 
relating to the clinical condition or treatment of the patient. The 
consultation could be between two practitioners, with or without the 
patient present, or between a specialty practitioner and a patient.
    In order to compete for the program, applicants must participate in 
a telemedicine network that includes at least three sites: A 
multispecialty entity (tertiary care hospital, multi-specialty clinic, 
or a collection of facilities that, combined, could provide 24-hour a 
day specialty consultations), a small rural hospital (fewer than 100 
beds), a rural primary care practitioner office or clinic. Networks 
that include a long-term care facility are especially encouraged. The 
network may include additional rural sites, such as mental health 
clinics, school-based clinics, emergency service providers, home health 
providers, community and migrant health centers, rural health clinics, 
Federally qualified health centers, health professions schools, etc. 
The telemedicine network must be used to provide clinical consultations 
between the multispecialty entity (hub) and the rural sites (spokes). 
Projects that use low cost technologies are particularly encouraged.
    For purposes of this grant program, a telemedicine network is 
characterized by a full partnership among all the members that includes 
the following elements: (1) Resource participation; (2) a specific role 
for each member; (3) a contractual relationship; (4) a long-term 
commitment to the project by each member; (5) documentation of the 
network's activities; and (6) active participation by each member so 
that the network is not solely dependent on any particular member 
organization.
    The applicant must be willing to participate in an evaluation of 
telemedicine services. This may include, but is not limited to, 
collecting data, completing surveys, and participating in on-site 
observations by independent evaluators.
    In order to facilitate an evaluation of telemedicine, it is 
important that there be some level of uniformity in the types of 
clinical services provided among the projects. All projects, at a 
minimum, must be able to provide teleconsultations in the following 
services: Teleradiology, cardiology, dermatology, mental health and/or 
substance abuse, obstetrics and gynecology, orthopedics, subspecialties 
of pediatrics, and resuscitation of trauma patients. Applicants may 
propose to provide teleconsultations for additional services.
    This grant program is intended to support telemedicine for medical 
diagnosis and treatment of patients, including patient counseling. It 
is not for didactic distance learning programs, such as lectures or 
other programs designed solely for the purposes of instructing health 
care personnel or patients.
    Applicants must develop projects to address specific, well-
documented needs of the rural communities. In doing so, applicants are 
advised to consider both the health care needs of the rural communities 
served by the project, and the extent to which the project can build 
upon existing telecommunications capacity in the communities to 
facilitate efficient use of that capacity by multiple users. Needs can 
be established through a formal needs assessment or by population 
specific demographic data.
    All the grant funding must be used for services provided to or in 
rural communities. A majority of grant dollars must actually be spent 
in rural communities for direct services to those communities, 
including salaries, maintenance of equipment, and transmission costs.

Eligible Applicants

    A grant award will be made only to an entity that is part of a 
telemedicine network and can provide a wide range of specialty 
consultation services on a 24-hour basis to rural spoke sites. The 
grant recipient can be a public (non-Federal) or private entity located 
in either a rural or urban area. Rural spoke sites may be public or 
private entities, either nonprofit or for-profit. All spoke facilities 
supported by this grant must meet one of the two requirements stated 
below.

    (1) The facility is located outside of a Metropolitan 
Statistical Area as defined by the OMB. A list of the cities and 
counties that are designated as being within a Metropolitan 
Statistical Area will be included with the application kit.
    (2) The facility is located in a rural census tract of one of 
the counties listed in Appendix I to this announcement. Although 
each of these counties is a Metropolitan Statistical Area, or part 
of one, large parts of the counties are rural. Facilities located in 
these rural areas are eligible for the program. Rural portions of 
these counties have been identified by census tract since this is 
the only way we have found to clearly differentiate them from urban 
areas in the large counties. Appendix I provides a list of these 
census tracts for each county. Appendix II includes the telephone 
numbers for regional offices of the Census Bureau. Applicants may 
call these offices to determine the census tract in which they are 
located.

Review Procedure

    Applications will be assessed by the Office of Grants Management 
for responsiveness to this notice. Any applications that are judged 
nonresponsive because they are inadequately developed, in an improper 
format, exceed the specified page length, or otherwise are unsuitable 
for peer review and funding consideration, will be returned without 
further consideration. All responsive applications will undergo 
objective peer review.

Review Consideration

    Grant applications will be evaluated on the basis of the following 
criteria:
    (1) The extent to which the project facilitates development of 
an integrated system of care for the rural areas served by the 
project by providing referral linkages, facilitating consultations 
among health care professionals, and reducing the isolation of 
health care practitioners.
    (2) The strength of the relationships among members of the 
telemedicine network as demonstrated by the contractual 
arrangements.
    (3) A demonstrated ability to collect data and participate in an 
evaluation of telemedicine.
    (4) A demonstrated capability, experience, and knowledge of the 
applicant and others who will be responsible for the project to 
carry out the project.
    (5) The reasonableness of the budget proposed for the project.
    (6) The level of local commitment and involvement with the 
project, including the extent of cost participation by the applicant 
and/or other organizations.
    (7) The extent to which the applicant has justified and 
documented the need(s) for the project and developed measurable 
goals and objectives for meeting the need(s).
    (8) The feasibility of plans to continue the project after 
Federal grant support has ended.
    (9) The extent to which the proposed project would be capable of 
replication in rural areas with similar needs and characteristics, 
particularly with regards to its affordability by other communities.

Other Information

    Applicants are advised that the narrative description of their 
program and the budget justification may not exceed 30 pages in length. 
Applications that exceed the 30 page limit for the program narrative 
and budget justification will not receive consideration. All 
applications must be typewritten and clearly legible, using print no 
smaller than 12 characters per inch and having no less than one-half 
inch margin on all sides.

Public Health System Impact Statement

    This program is subject to the Public Health System Reporting 
Requirements. Reporting requirements have been approved by the OMB--
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 non governmental 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 of local health agencies.

Executive Order 12372

    The Rural Telemedicine Grant program has been determined to be a 
program that 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. Applicants (other than Federally-recognized 
Indian tribal governments) should contact their State Single Point of 
Contact (SPOCs), a list of which will be included in the application 
kit, 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 then one State, the applicant is advised 
to contact the SPOC of each affected State. All SPOC recommendations 
should be submitted to Opal McCarthy, Office of Grants Management, 
Bureau of Primary Health Care, East West Building, 11th floor, 4350 
East West Highway, Rockville, Maryland 20857, (301) 594-4260. 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'' for 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.

    OMB Catalog of Federal Domestic Assistance number is 93.211.

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

Appendix I

    * Census tract numbers are shown below each county name.

State

County

Tract Number

Alabama

Baldwin

0101
0102
0106
0110
0114
0115
0116

Mobile

0059
0062
0066
0072.02

Tuscaloosa

0107

Arizona

Maricopa

0101
0405.02
0507
0611
0822.02
5228
7233

Pima

0044.05
0048
0049

California

Butte

0024
0025
0026
0027
0028
0029
0030
0031
0032
0033
0034
0035
0036

El Dorado

0301.01
0301.02
0302
0303
0304.01
0304.02
0305.01
0305.02
0305.03
0306
0310
0311
0312
0313
0314
0315

Fresno

0040
0063
0064.01
0064.03
0065
0066
0067
0068
0071
0072
0073
0074
0077
0078
0079
0080
0081
0082
0083
0084.01
0084.02

Kern

0033.01
0033.02
0034
0035
0036
0037
0040
0041
0042
0043
0044
0045
0046
0047
0048
0049
0050
0051.01
0052
0053
0054
0055.01
0055.02
0056
0057
0058
0059
0060
0061
0063

Los Angeles

5990
5991
9001
9002
9004
9012.02
9100
9101
9108.02
9109
9110
9200.01
9201
9202
9203.03
9301

Monterey

0109
0112
0113
0114.01
0114.02
0115

Placer

0201.01
0201.02
0202
0203
0204
0216
0217
0219
0220

Riverside

0421
0427.02
0427.03
0429
0430
0431
0432
0444
0452.02
0453
0454
0455
0456.01
0456.02
0457.01
0457.02
0458
0459
0460
0461
0462

San Bernardino

0089.01
0089.02
0090.01
0090.02
0091.01
0091.02
0093
0094
0095
0096.01
0096.02
0096.03
0097.01
0097.03
0097.04
0098
0099
0100.01
0100.02
0102.01
0102.02
0103
0104.01
0104.02
0104.03
0105
0106
0107

San Diego

0189.01
0189.02
0190
0191.01
0208
0209.01
0209.02
0210
0212.01
0212.02
0213

San Joaquin

0040
0044
0045
0052.01
0052.02
0053.02
0053.03
0053.04
0054
0055

Santa Barbara

0018
0019.03

Santa Clara

5117.04
5118
5125.01
5127

Shasta

0126
0127
1504

Sonoma

1506.04
1537.01
1541
1542
1543

Stanislaus

0001
0002.01
0032
0033
0034
0035
0036.05
0037
0038
0039.01
0039.02

Tulare

0002
0003
0004
0005
0006
0007
0026
0028
0040
0043
0044

Ventura

0001
0002
0046
0075.01

Colorado

Adams

0084
0085.13
0087.01

El Paso

0038
0039.01
0046

Larimer

0014
0017.02
0019.02
0020.01
0022

Pueblo

0028.04
0032
0034

Weld

0019.02
0020
0024
0025.01
0025.02

Florida

Collier

0111
0112
0113
0114

Dade

0115

Marion

0002
0004
0005
0027

Osceola

0401.01
0401.02
0402.01
0402.02
0403.01
0403.02
0404
0405.01
0405.02
0405.03
0405.05
0406

Palm Beach

0079.01
0079.02
0080.01
0080.02
0081.01
0081.02
0082.01
0082.02
0082.03
0083.01
0083.02

Polk

0125
0126
0127
0142
0143
0144
0152
0154
0155
0156
0157
0158
0159
0160
0161

Kansas

Butler

0201
0203
0204
0205
0209

Louisiana

Rapides

0106
0135
0136

Terrebonne

0122
0123

Minnesota

St. Louis

0105
0112
0113
0114
0121
0122
0123
0124
0125
0126
0127
0128
0129
0130
0131
0132
0133
0134
0135
0137.01
0137.02
0138
0139
0141
0151
0152
0153
0154
0155

Stearns

0103
0105
0106
0107
0108
0109
0110
0111

Montana

Cascade

0105

Yellowstone

0015
0016
0019

Nevada

Clark

0057
0058
0059

Washoe

0031.04
0032
0033.01
0033.02
0033.03
0033.04
0034

New Mexico

Dona Ana

0014
0019

Santa Fe

0101
0102
0103.01

New York

Herkimer

0101
0105.02
0107
0108
0109
0110.01
0110.02
0111
0112
0113.01

North Dakota

Burleigh

0114
0115

Grand Forks

0114
0115
0116
0118

Morton

0205

Oklahoma

Osage

0103
0104
0105
0106
0107
0108

Oregon

Clackamas

0235
0236
0239
0240
0241
0243

Jackson

0024
0027

Lane

0001
0005
0007.01
0007.02
0008
0013
0014
0015
0016

Pennsylvania

Lycoming

0101
0102

South Dakota

Pennington

0116
0117

Texas

Bexar

1720
1821
1916

Brazoria

0606
0609
0610
0611
0612
0613
0614
0615
0616
0617
0618
0619
0620.01
0620.02
0621
0622
0623
0624
0625.01
0625.02
0625.03
0626.01
0626.02
0627
0628
0629
0630
0631
0632

Harris

0354
0544
0546

Hidalgo

0223
0224
0225
0226
0227
0228
0230
0231
0243

Washington

Benton

0116
0117
0118
0119
0120

Franklin

0208

King

0327
0328
0330
0331

Snohomish

0532
0536
0537
0538

Spokane

0101
0102
0103.01
0103.02
0133
0138
0143

Whatcom

0110

Yakima

0018
0019
0020
0021
0022
0023
0024
0025
0026

Wisconsin

Douglas

0303

Marathon

0017
0018
0020
0021
0022
0023

Wyoming

Laramie

0016
0017
0018

Appendix II

Bureau of the Census Regional Information Service

Atlanta, GA--404-730-3957
    Alabama, Florida, Georgia
Boston, MA--617-565-7078
    Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, 
Vermont, Upstate New York
Charlotte, NC--704-344-6144
    Kentucky, North Carolina, South Carolina, Tennessee, Virginia
Chicago, IL--708-409-4617
    Illinois, Indiana, Wisconsin
Dallas, TX--214-767-7105
    Louisiana, Mississippi, Texas
Denver, CO--303-969-7750
    Arizona, Colorado, Nebraska, New Mexico, North Dakota, South 
Dakota, Utah, Wyoming
Detroit, MI--313-354-4654
    Michigan, Ohio, West Virginia
Kansas City, KS--913-236-3711
    Arkansas, Iowa, Kansas, Missouri, New Mexico, Oklahoma
Los Angeles, CA--818-904-6339
    California
New York, NY--212-264-4730
    Brooklyn, Bronx, Manhattan, Queens, Staten Island, Nassau Co., 
Orange Co., Suffolk Co., Rockland Co., Westchester Co.
Philadelphia, PA--215-597-8313
    Delaware, District of Columbia, Maryland, New Jersey, 
Pennsylvania
Seattle, WA--206-728-5314
    Idaho, Montana, Nevada, Oregon, Washington

[FR Doc. 94-6283 Filed 3-17-94; 8:45 am]
BILLING CODE 4160-15-P