[Federal Register Volume 59, Number 79 (Monday, April 25, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-9865]


[[Page Unknown]]

[Federal Register: April 25, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement No. 418]
RIN 0905-ZA05

 

Project Grants--Health Programs for Refugees; Availability of 
Funds for Fiscal Year 1994

Introduction

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 1994 funds for a grant program for 
refugees. 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 to reduce morbidity and mortality 
and improve the quality of life. This announcement is related to the 
priority area of Immunization and Infectious Diseases. (For ordering a 
copy of ``Healthy People 2000,'' see the section ``Where To Obtain 
Additional Information''.)

Authority

    This program is authorized by section 412(b)(5) of the 
Immigration and Nationality Act [8 U.S.C. 1522(b)(5)], as amended.

Smoke-Free Workplace

    The PHS 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.

Eligible Applicants

    Eligible applicants for this program are the official State health 
agencies and current official public health agencies of political 
subdivisions who are recipients of Health Program for Refugees project 
grant program (New York City; Philadelphia, PA; Barren River District, 
KY; Missoula City, MT; Maricopa County, AZ; North Central District, 
ID).

National Program Goals

    The National Program Goals are:
    A. As a high priority, to prevent and control health problems of 
public health significance among refugees;
    B. As a lesser priority incidental to the provision of services 
under A., to improve the general health status of the refugee 
population through health assessment and referral, emphasizing those 
health problems that may impede effective resettlement and prevent 
economic self-sufficiency.

Availability of Funds

    Approximately $2,700,000 is expected to be available in FY 1994 to 
fund all approved competing grants. It is expected that the average 
award will be $56,000, ranging from $5,000 to $900,000, beginning on or 
about July 1, 1994, for a 12-month budget period within a 5-year 
project period. Funding estimates may change. There is no statutory 
cost participation formula.
    In agreement with the Office of Refugee Resettlement, CDC will 
distribute available funds on an 80% formula and 20% discretionary 
basis. (Applicants will continue to submit budgets as in previous 
years, i.e., line item detail with a ``Grand Total'' amount of funding 
requested.) CDC will distribute 80% of the available funds (e.g., 
$2,160,000 of the $2,700,000) to grantees based on a formula using each 
State's proportion of refugee arrivals during the past two years 
(including a floor amount of $5,000 for States with a small number of 
refugee arrivals). All applicants with approved applications will 
receive formula funding. The remaining 20% of available funding (e.g., 
$540,000 of the $2,700,000) will be awarded on a discretionary basis.

Use of Grant Funds

    Grant funds may be used for costs associated with planning, 
organizing, implementing, and evaluating public health and health 
assessment activities directed to refugees, in accordance with 45 CFR 
parts 74 and 92. Grant funds may not be used for construction costs or 
inpatient care.
    Except in special situations that are explained and justified, 
grant funds will not be available for direct curative or rehabilitative 
services. This restriction applies to subsequent diagnostic or 
treatment services provided directly to individual refugees for whom 
specific health problems have been identified. It is expected that 
other sources of support will generally be identified for these 
purposes. Exceptions will be considered for diagnostic and treatment 
services that are integral to the conduct of public health programs and 
are otherwise not available. However, tuberculosis preventive therapy 
outreach activities that are associated with locating refugees for 
diagnosis and the provision of treatment are permitted.
    If grant funds are used to support bilingual outreach staff, 
applicants should ensure appropriate language and culture 
compatibility. Applicants are encouraged to use contractual or similar 
mechanisms that will allow for maximum flexibility in making personnel 
changes due to changing language needs.

Purpose

    The purpose of this program is to augment State and local resources 
and to assist States and localities in providing health assessments and 
follow-up activities to refugees for problems of public health concern. 
Health assessments of refugees are intended to identify and lead to the 
treatment of health conditions that could affect the public health or 
the personal well-being of refugees and impede their effective 
resettlement. Communities with the largest refugee populations will be 
principally targeted for assistance under this program.
    The term ``refugee'' is defined in section 101(a)(42) of the 
Immigration and Nationality Act [8 U.S.C. 1101(a)(42)].
    These grants are made available in recognition of:
    A. The severe strain on public resources in high impact areas 
represented by the influx of refugees.
    B. Gaps in meeting the health needs of refugees through other forms 
of Federal assistance.
    C. The need for State level coordination of public health programs, 
general health assessments, and referrals for medical, mental, dental, 
rehabilitative, and social services.
    D. The need to intensify and maintain outreach efforts to improve 
upon the number of refugees starting and completing tuberculosis 
preventive therapy.

Program Requirements

    In conducting the activities to achieve the purpose of the program, 
the Grantees must meet the following requirements:

A. Identification

    Develop and implement a system to identify all officially arriving 
refugees. Use notification forms received from CDC port of entry 
quarantine stations to determine primary refugee arrivals. Include a 
mechanism to identify secondary refugee arrivals and give priority to 
recent arrivals in the United States who have not received an initial 
health assessment in their area of previous residence.

B. Contacting Refugees

    Contact identified officially arriving refugees shortly after 
arrival and offer a health assessment. Carefully explain the importance 
of receiving a health assessment and where and how to get to a 
convenient health care provider, whenever possible, in the language 
spoken by the refugee. Efforts to contact the refugees should include:
    1. Close coordination with voluntary agencies (VOLAGS) and other 
service agencies.
    2. Assisting the refugee to overcome any special barriers to 
receiving the health assessment, e.g., lack of transportation.

C. Health Assessment

    Provide or coordinate the provision of a health assessment to 
officially arriving refugees and identified secondary migrants who have 
not previously received a health assessment. Give priority to refugees 
with Class A and Class B medical conditions. Although it is expected 
that a standard protocol and recommended priorities for health 
assessments will be published at a later date, applicants may include 
the following components in the health assessment:
    1. Screening for tuberculosis, including a tuberculosis skin test 
and a chest X-ray if a recent one is not available;
    2. Public health history and review of current problems, including 
immunization needs;
    3. Screening of pregnant women for hepatitis B;
    4. Testing for intestinal parasites;
    5. Testing for anemia;
    6. Complete physical examination including:
    a. Oral inspection for dental problems;
    b. Height and weight measurement to assess pediatric nutritional 
status;
    c. Vision and hearing testing; and,
    d. Test for hypertension.

D. Referrals for Health Problems

    Refer refugees with health problems identified during the health 
assessment to the appropriate health care provider for treatment. 
Establish a system for follow-up, based on the priority of the 
condition identified, to ensure appointments are kept.

E. Health Education

    In order for the refugees to be successfully assimilated into the 
public health care system, the importance of preventive health should 
be taught as part of the health assessment process. Refugees should be 
informed, in their own language, about the tests they are receiving and 
what the results of the tests mean. The need for obtaining additional 
care, testing, and treatment for an identified health problem should 
also be carefully explained. Culturally competent and linguistically 
appropriate educational pamphlets, slides, or videos, and individual or 
group education sessions may be used to provide this information. The 
applicant may also provide or coordinate the provision of culturally 
sensitive training for staff working with refugees.

F. Coordination with Other Agencies/Organizations

    To promote the national goals and use all existing resources to 
this end, place special emphasis on coordinating efforts with:
1. Voluntary agencies (VOLAGS);
2. Mutual assistance agencies (MAA);
3. State Department of Social Services;
4. State Advisory Council on Refugee Affairs;
5. Other State and Federally funded programs, such as Medicaid, and 
health department immunization and tuberculosis control programs;
6. Private providers of health care to refugees.

Evaluation Conditions and Criteria

A. Formula Conditions

    Eligible applicants meeting the following conditions will receive 
an award based on the formula described in the ``Availability of 
Funds'' section.
    1. Has the applicant provided a budget justification and plan of 
operation and evaluation?
    2. Does the application document the size of the refugee 
population, including secondary migrants?
    3. Are the proposed objectives specific, measurable, realistic, 
time-phased, and related to the National Program Goals?
    4. Does the application document coordination with the State 
Refugee Resettlement Coordinator?

B. Discretionary Award Evaluation Criteria

    Applications will be reviewed and evaluated according to the 
following criteria, each carrying equal weight of 25 points:
    1. Does the application document the need for support, including:
    a. The extent and distribution of unique refugee health problems;
    b. The extent and distribution of general refugee health problems;
    c. The relationship of the project to existing services?
    2. Does the application include a plan for conducting project 
activities described in the program description that is consistent with 
the State Refugee Resettlement Plan and that will integrate refugees 
into existing health services?
    3. Does the application include reasonable and appropriate methods 
for evaluating the project's effectiveness?
    In addition, in determining discretionary award amounts, CDC will 
consider the applicant's proposed use of project funds, program 
potential, other funding resources, past performance and funding, the 
quality of the data collection system, appropriateness and 
reasonableness of the budget request, and plans to provide tuberculosis 
preventive therapy and outreach services.

Other Reviews

    The State Refugee Resettlement Coordinator should have an 
opportunity to review and comment on the application prior to its 
submission.

Other Requirements

Human Subjects

    If the proposed project involves research on human subjects, the 
applicant must comply with the Department of Health and Human Services 
Regulations (45 CFR part 46) regarding the protection of human 
subjects. Assurance must be provided to demonstrate that the project 
will be subject to initial and continuing review by an appropriate 
institutional review committee. The applicant will be responsible for 
providing assurance in accordance with the appropriate guidelines and 
form provided in the application kit.

Executive Order 12372 Review

    Applications are subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets 
up a system for State and local government review of proposed Federal 
assistance applications. Applicants should contact their State Single 
Point of Contact (SPOC) 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 for each affected State. A 
current list of SPOCs is included in the application kit. If SPOCs have 
any State process recommendations on applications submitted to CDC, 
they should send them to Elizabeth M. Taylor, Grants Management 
Officer, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road NE., Mailstop E-16, Atlanta, GA 30305, no later than 60 days after 
the application deadline. The Program Announcement Number and Program 
Title should be referenced on the document. The granting agency does 
not guarantee to ``accommodate or explain'' State process 
recommendations it receives after that date.

Public Health System Reporting Requirements

    This program is not subject to the Public Health System Reporting 
Requirements.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance Number is 93.987, Health 
Programs for Refugees.

Application Submission and Deadline

    The program announcement and application kit were sent to all 
eligible applicants in February 1994.

Where To Obtain Additional Information

    Business management technical assistance including information on 
application procedures and copies of application forms may be obtained 
from Bernice A. Moore, Grants Management Specialist, Grants Management 
Branch, Procurement and Grants Office, Centers for Disease Control and 
Prevention (CDC), 255 East Paces Ferry Road, NE., Mailstop E16, 
Atlanta, GA 30305, telephone (404) 842-6802. Announcement No. 418, 
``Project Grants--Health Programs for Refugees,'' must be referenced in 
all requests for information pertaining to this project.
    Programmatic technical assistance may be obtained from Richard D. 
Moyer, Chief, Medical Screening and Health Assessment Branch, Health 
Programs for Refugees, Division of Quarantine, Center for Prevention 
Services, Centers for Disease Control and Prevention (CDC), Mailstop 
EO3, Atlanta, GA 30333, telephone (404) 639-8110.
    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) referenced in the ``Introduction'' may be obtained through the 
Superintendent of Documents, Government Printing Office, Washington, DC 
20402-9325, telephone (202) 783-3238.

    Dated: April 18, 1994.
Robert L. Foster,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 94-9865 Filed 4-22-94; 8:45 am]
BILLING CODE 4163-18-P