[Federal Register Volume 59, Number 89 (Tuesday, May 10, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11143]


[[Page Unknown]]

[Federal Register: May 10, 1994]


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Department of Health and Human Services

Health Resources and Services Administration
[PN 2217]
RIN 0905-ZA43

 

Availability of Funds for Grants for School Health Services and 
Health Education/Promotion for Homeless and At-Risk Children and Youth, 
and for School Health Staff Development

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 the availability of approximately $5.75 million under the 
appropriation for fiscal year (FY) 1994, for HRSA's new school health 
initiative: the Healthy Schools, Healthy Communities Initiative. The 
Bureau of Primary Health Care (BPHC) and the Maternal and Child Health 
Bureau (MCHB) will jointly manage this initiative within HRSA.
    Under this initiative, approximately $3.25 million is available for 
discretionary grants to provide school-based primary health care 
services to homeless and at-risk children and youth. This money was 
appropriated under Public Law 103-112, the FY 1994 Labor/HHS 
Appropriations Act, and is included as part of the funding for the 
Outreach and Primary Health Services for Homeless Children Program. The 
grants will be awarded under section 340(s) of the Public Health 
Service (PHS) Act, 42 U.S.C. 256.
    The remainder of the funding for the initiative, approximately $2.5 
million, is available through MCHB's Special Projects of Regional and 
National Significance (SPRANS) as authorized under section 501(a)(2) of 
the Social Security Act, 42 U.S.C. 701(a)(2). One million dollars of 
the SPRANS money is for health education/promotion services provided to 
homeless and at-risk children and youth through school-based health 
centers. The remaining $1.5 million is available for school health 
staff development grants.
    The $5.75 million for the Healthy Schools, Healthy Communities 
Initiative will be awarded through two grant programs. First, $4.25 
million is available for grants to provide school-based primary health 
care services and health education/promotion for homeless and at-risk 
children and youth. Second, $1.5 million is available for grants for 
school health staff development.
    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. The Healthy Schools, Healthy 
Communities Initiative will contribute to meeting the objectives cited 
for children and youth, particularly children and youth who are 
homeless, at-risk, in low-income families, and/or minorities. In 
addition, the initiative will contribute to meeting three of the six 
National Education Goals included in the Goals 2000: Educate America 
Act. The initiative will address Goal 1 which states: by the year 2000, 
all children in America will start school ready to learn; Goal 2 which 
states: by the year 2000, the high school graduation rate will increase 
to at least 90 percent, and Goal 6 which states: by the year 2000, 
every school in America will be free of drugs and violence and will 
offer a disciplined environment conducive to learning. In addition, 
this program is consistent with many of the elements of the proposed 
Health Security Act, particularly Title III, Subtitle G. Potential 
applicants may obtain a copy of Healthy People 2000 (Full Report--Stock 
No. 017-001-00474-0 or 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 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.

DUE DATES: To receive consideration, applications for the health 
services/health education grant and the staff development grant are due 
July 15, 1994. Applications are considered as having met the deadline 
if they are: (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 obtain a legibly dated 
receipt from a commercial carrier or the U.S. Postal Service or obtain 
a legibly dated U.S. Postal Service postmark. Private metered postmarks 
will not be accepted as proof of timely mailing. Late applications will 
not be considered for funding and will be returned to the applicant.

ADDRESSES FOR HEALTH SERVICES/EDUCATION GRANTS: Application kits and 
additional guidance (Form PHS 5161-1 with revised face sheet DHHS form 
424, as approved by the OMB under control number 0937-0189) for the 
health services/health education grants may be obtained from, and 
completed applications should be mailed to: Alice H. Thomas, Grants 
Management Officer (GMO), Bureau of Primary Health Care, Health 
Resources and Services Administration, 4350 East-West Highway, 
Bethesda, Maryland, 20814. The telephone number is (301) 594-4260 and 
the fax number is (301) 594-4073. Application kits will be distributed 
up to two weeks before the application due date. The Grants Management 
staff is available to provide assistance on business management issues.

ADDRESSES FOR STAFF DEVELOPMENT GRANTS: Application kits and additional 
guidance (Form PHS 5161-1 with revised face sheet DHHS form 424, as 
approved by the OMB under control number 0937-0189) for the staff 
development grants may be obtained from, and completed applications 
should be mailed to: John Gallicchio, Grants Management Officer, 
Maternal and Child Health Bureau, Health Resources and Services 
Administration, Parklawn Building, Room 18-12, 5600 Fishers Lane, 
Rockville, Maryland, 20857. The telephone number is (301) 443-1440 and 
the fax number is (301) 443-6686. Application materials will be 
available after April 1, 1994.

FOR FURTHER INFORMATION CONTACT: For general program information and 
technical assistance, contact Jane Martin, Program Director, School 
Health Program, Perinatal and Child Health Branch, Division of Programs 
for Special Populations, Bureau of Primary Health Care, 4350 East-West 
Highway, Bethesda, Maryland 20814, (301) 594-4470, fax (301) 594-4989, 
or contact Linda Johnston, Co-Director, School Health Initiative, 
Adolescent Health Branch, Division of Maternal, Infant and Child 
Health, Maternal and Child Health Bureau, Parklawn Building, room 18A-
39, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 443-4026, fax 
(301) 443-1296.

SUPPLEMENTAl INFORMATION

School-Based Health Services and Health Education/Promotion Grants 
for Homeless and At-Risk Children and Youth

    Grant Amounts: Approximately $4.25 million is available for grants 
to provide school-based health services and health education/promotion 
to homeless and at-risk children and youth. Of the $4.25 million, $3.25 
million is for primary and preventive health care services; $1.0 
million is for health education/promotion purposes. Each grantee will 
only receive one grant award that will include funds for both health 
services and health education/promotion.
    Number of Awards: Approximately 15-20 awards will be made, with a 
total possible maximum of $285,000 for each grant. Awards will range 
from $100,000 to $220,000 for school-based health services and from 
$40,000 to $65,000 for school health education/promotion. Awards will 
be made for a one-year budget period and a three-year project period.
    Match Requirements: Only grantees that are hospitals are required 
to contribute (directly or through donations from public or private 
entities) not less than $1 in non-Federal contributions for each $1 of 
Federal funds provided in the health services portion of the grant. 
Non-Federal contributions may be in cash or in-kind, fairly evaluated, 
including plant, equipment, or other services. Amounts provided by the 
Federal Government, or services assisted or subsidized to any 
significant extent by the Federal Government, may not be included in 
determining the amount of such non-Federal contributions. It is 
important to note that this match does not apply to the health 
education/promotion portion of the grant.
    Eligible Applicants: An eligible applicant is a community-based 
primary health care provider. Eligible health care providers are 
community-based public or nonprofit private entities that have a 
history of providing primary health services to a substantial number of 
homeless, at-risk, or medically underserved children and youth in the 
community, e.g., health care for the homeless centers, community and 
migrant health centers, local health departments, public housing 
primary care centers, and children's hospitals.
    The provider must have established a partnership with a school or 
school district, but only the health care provider is the applicant. 
Together the health provider and school must have established a 
cooperative arrangement with at least one community organization that 
will supplement, expand, and enrich the services provided through the 
school-based health center. Applicants are encouraged to establish as 
many cooperative arrangements as are desirable and feasible (e.g., with 
Health Care for the Homeless projects, homeless shelters, soup 
kitchens, other community organizations that serve the homeless, 
community mental health centers, social service agencies, local youth 
organizations, and community service organizations).
    Grantees must have an agreement with a State under its Medicaid 
program, title XIX of the Social Security Act (if they provide services 
that are covered under the title XIX plan for the State), and be 
qualified to receive payments under the agreement. This requirement may 
be waived if the organization does not, in providing health care 
services, impose a charge or accept reimbursement available from any 
third-party payor, including reimbursement under any insurance policy 
or under any Federal or State health benefits program. It is expected 
that grantees will maximize third party reimbursement to which they are 
entitled, including Medicaid.
    Grants will be made for a variety of arrangements, including 
programs in rural and urban areas. Grants will be awarded for programs 
in elementary schools, middle schools or junior high schools, high 
schools, or a combination of schools. Funds are not available to 
enhance existing school-based health centers. The funds are intended to 
be used to establish new school-based health centers that offer 
comprehensive primary care services. An applicant that currently 
operates a school-based health center may use these funds to establish 
a new center in another school.
    Other Requirements: Restrictions on the use of grant funds are as 
follows: (1) Grant funds may not be used to pay for inpatient services, 
except for residential treatment for substance abuse provided in 
settings other than hospitals; (2) grant funds may not be used to make 
cash payments to intended recipients of primary health, substance abuse 
or mental health services; and (3) grant funds may not be used to 
purchase major medical equipment or to purchase or improve real 
property (other than minor remodeling of existing improvements to real 
property, which is allowable for rebudgeting without prior approval for 
amounts up to a cumulative maximum of $25,000). The Secretary may waive 
this restriction upon request by an applicant demonstrating that the 
purposes of the project cannot otherwise be carried out.
    The grantee must, directly or through contract, provide services 
without regard to ability to pay for the services. If a charge is 
imposed for the delivery of services, such charge: (1) Will be made 
according to a schedule of charges that is made available to the 
public; (2) will not be imposed on any individual with an income less 
than the official poverty level (the nonfarm income official poverty 
line defined by the Office of Management and Budget); and (3) will be 
adjusted to reflect the income and resources of the individual 
involved.
    Program Services: Grants will be awarded to school-based health 
center programs that will offer comprehensive primary care and health 
education/promotion services including, but not limited to: (1) 
Outreach and other access-related services including care coordination/
case management, translation, and transportation, as needed; (2) 
diagnosis and treatment of acute and chronic conditions; (3) laboratory 
services necessary to diagnose and treat acute and chronic conditions 
(these may be provided directly, through contract arrangements, or 
through formal referrals); (4) preventive health services, including 
health screenings and immunizations; (5) mental health and counseling 
services, and necessary referrals for child abuse prevention and 
treatment, specialized mental health services, social services, and 
substance abuse treatment; (6) preventive dental services (these may be 
provided directly, through contract arrangements, or through formal 
referrals); (7) a school health education/promotion program; and (8) 
arrangements for coverage during non-school hours. The health 
education/promotion activities should build on and be integrated with 
existing health education/promotion activities and should address the 
unmet needs of students.
    Target Populations: This program is designed to serve children in 
kindergarten through the twelfth grade who are homeless or at imminent 
risk of homelessness, including children in unstable housing situations 
or who have incomes or family incomes below 200% of the federal poverty 
level (the nonfarm income official poverty line defined by the Office 
of Management and Budget).
    While the school-based health center will target services to those 
children described above, the school-based health center must serve all 
students in the school who wish to enroll in the center.
    Data and Management Information System (MIS) Requirements: The 
funding agencies will provide the software to be used for the 
acquisition of data needed for program monitoring and the national 
evaluation. Purchase of appropriate hardware to run the software will 
be an allowable expense under the grant. The system to be employed will 
meet very specific requirements to be further articulated in the 
program guidance. Broad data categories include, but are not limited 
to, demographics, insurance status, diagnoses, services provided, 
referrals, and follow-up. The data requirements for the national 
evaluation are subject to OMB approval and will not be implemented 
until approval is obtained.
    Criteria for Evaluation: Applicants will be evaluated on their plan 
for health services and health education/promotion based upon the 
following criteria:
     Need: Degree of need for school-based health services, 
which must include but not be limited to the following indicators: (1) 
Estimate of the number of homeless children and children at imminent 
risk of homelessness in the school and community, with estimation 
method specified; (2) level of poverty in school and community, 
including school receipt of Chapter 1 funds, and in particular, school 
designation as a Chapter 1 school-wide program; (3) the number of 
children who are eligible for free or reduced price lunches; (4) degree 
to which the population in the community is medically underserved; (5) 
presence of significant barriers to health care for students in the 
community (e.g., lack of transportation, language); and (6) indicators 
of health risks for school-aged children and youth such as intentional 
and unintentional injuries, violence, alcohol and other drug abuse, 
sexually transmitted disease, adolescent pregnancy, juvenile justice 
involvement, and high proportion of children with special health care 
needs;
     Proposed Plan and Project Description: The extent to which 
the applicant has: (1) Demonstrated its capability to successfully 
implement and administer the proposed plan; (2) specified appropriate 
and measurable goals and objectives that address the needs of the 
target population identified through a completed community needs 
assessment; (3) demonstrated the feasibility of implementing the 
program based on the time frame proposed; (4) described an appropriate 
multidisciplinary team of health professionals who will deliver 
services; (5) provided for an arrangement between the health care 
provider and the school that specifies how referrals and off site 
treatment will be handled and, where appropriate, specified the role of 
the school nurse, school psychologist, and other school personnel in 
the staffing of the clinic and the provision of health services to 
students; (6) outlined a suitable quality assurance program for 
services provided under the grant; (7) specified administrative 
procedures for fiscal control and fund accounting procedures which 
provide for reasonable financial administration of Federal and non-
Federal funds; (8) specified plans for and evidence of financial 
ability to continue program beyond project period; (9) included health 
education/promotion activities that will adequately address unmet 
health education needs of students; (10) integrated health education/
promotion services with new and existing school health services, health 
education/promotion programs, and other education programs, if any, 
(e.g., counseling, special education, services provided by a school 
nurse, including those provided under IDEA, and activities funded under 
the Drug Free Schools and Communities Act); and (11) specified health 
education/promotion activities that complement the existing health 
education curriculum (the activity should target those health 
education/promotion needs which are identified as top priority based 
upon the needs assessment);
     Project Collaboration, Coordination and Community Support: 
(1) The extent to which the health provider and school have established 
cooperative arrangements with community groups that will supplement, 
expand, and enrich the services provided through the school-based 
health center; (2) the degree to which the applicant has and will 
continue to work with other Federal, State and local programs 
(particularly State health agencies and their Primary Care Cooperative 
Agreement staff and the Maternal and Child Health (Title V) staff, 
local schools, mental health service agencies, substance abuse service 
agencies, and Medicaid); (3) the extent of community support, 
particularly among families, caregivers and the students themselves; 
(4) the extent of support from school personnel and organizations 
(e.g., principal, school board, school nurses, PTA, Student Council); 
and (5) evidence of willingness of collaborating and/or supporting 
organizations to contribute resources, both cash and in kind, for the 
school-based health center program;
     Budget: Adequacy and appropriateness of the proposed 
budget (i.e., detailed projections of revenue and costs in accordance 
with grant application instructions), including the health education/
promotion budget subsection;
     Outcome and Evaluation: (1) The strength of the self-
evaluation plan to monitor the progress of the program and to assess 
and document outcomes of the program; and (2) evidence of applicant's 
commitment to participate in a national evaluation and use the software 
provided by the funding agency.

SUPPLEMENTAL INFORMATION

School Health Staff Development Grants

    Background: The purpose of these grants is to build capacity at the 
State and local levels, consistent with the goals of the proposed 
Health Security Act, in order to provide staff development for local 
education agency and local health agency personnel involved in school-
based health centers or in school-linked programs. Proposed programs 
could include training for the following types of staff: health care 
providers, allied health professionals, and health educators. Emphasis 
should be placed on training to work with a multidisciplinary team.
    Grant Amounts and Number of Awards: There will be approximately 
$1.5 million available for up to 10 school health staff development 
grants for Fiscal Year 1994, to enhance the operation of school-related 
health services. Awards will be made for a one-year budget and project 
period.
    Eligible Applicants: Eligible applicants are State health agencies 
or public and private nonprofit institutions of higher learning. The 
applicant must demonstrate full partnership between the State health 
agency and the institution of higher learning and, as appropriate, 
other community organizations and/or professional associations.
    Criteria for Evaluation: Grantees will be evaluated based upon the 
following criteria:
     Need: Degree of need for school health program staff 
development as identified in a needs assessment;
     Proposed Plan: The extent to which the proposed plan has: 
(1) Specified appropriate goals and objectives (e.g., specify knowledge 
expected to be learned to upgrade skills and competencies to work in 
school health settings); (2) provided a description of proposed program 
to provide staff development for individuals who work in school health 
settings; (3) utilized existing staff development programs, where 
appropriate (e.g., the Interdisciplinary Adolescent Health Project(s) 
and the Center for Continuing Education in Adolescent Health supported 
by funds from MCHB); and (4) demonstrated the soundness of the 
project's proposed management, as assessed by the qualifications of the 
staff of the proposed project, the applicant's facilities and 
resources, and the capability to fulfill the proposed goals and 
objectives to meet staff development needs;
     Budget: Adequacy and appropriateness of proposed budget;
     Outcome and Evaluation: (1) The adequacy of the plan to 
monitor the progress of the program and to assess and document outcomes 
of the program; and (2) evidence of commitment to participate in a 
national evaluation.

Other Award Information

    The programs under the Healthy Schools, Healthy Communities 
Initiative are 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 appropriate deadline dates. The Health Resources and 
Services Administration does not guarantee that it will accommodate or 
explain its responses to State process recommendations received after 
the due date. (See ``Intergovernmental Review of Federal Programs'', 
Executive Order 12372, and 45 CFR part 100, for a description of the 
review process and requirements.)
    These programs are subject to the Public Health System Reporting 
Requirements 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 
certain information to the head of the appropriate State and local 
health agencies in the area(s) to be impacted. This information should 
be submitted no later than the Federal application receipt due date. 
The information includes:
    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 and local health agencies.
    The OMB Catalog of Federal Domestic Assistance numbers for the HRSA 
Healthy Schools, Healthy Community Initiative are 93.151 and 93.110.

    Dated: March 18, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-11143 Filed 5-9-94; 8:45 am]
BILLING CODE 4160-15-P