[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]
BILLING CODE 4160-15-M