[Federal Register Volume 60, Number 21 (Wednesday, February 1, 1995)]
[Notices]
[Pages 6138-6140]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-2432]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Financial Assistance for Telemedicine Demonstration 
Project in Rural Western Nebraska

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

ACTION: Notice of availability of funds.

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SUMMARY: The Office of Rural Health Policy, HRSA, announces the 
availability of funds in FY 1995 for a grant to support a telemedicine 
demonstration project in rural western Nebraska. The purpose of the 
grant is to (1) develop a base of information that will contribute to a 
systematic evaluation of telemedicine systems serving rural areas; and 
(2) facilitate development of a rural health care network through the 
use of telemedicine.

Authority

    The award will be made from funds appropriated under Public Law 
103-333 (HHS Appropriation Act for FY 1995). The Senate Committee on 
Appropriations Report 103-318 included a set-aside to support a 
multipurpose telecommunication system in rural western Nebraska. In 
introducing the set-aside for this project, the Senate Report stated: 
``Communication systems that link physicians offices to hospitals are 
necessary for establishing functioning networks in rural areas.'' The 
Department agrees that the objectives of this set-aside are consistent 
with the general provisions of the Office of Rural Health Policy's 
telemedicine grant programs, which are authorized under Section 301 of 
the Public Health Service Act.

Justification for Other Than Full and Open Competition

    In the Senate Committee on Appropriations Report 103-318, the 
Senate directed this demonstration to be awarded only to applicants in 
rural western Nebraska. The Senate Report does not specify the areas to 
be included in the definition of ``rural western 
[[Page 6139]] Nebraska.'' In the absence of such a definition, the 
Department considers all applicants in counties that are geographically 
located in the western third of the state to be eligible for this 
competition.

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. This grant 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

    Depending on the availability of funds, which are subject to 
reductions in the appropriated amounts, an estimated total award of up 
to $500,000 will be made to support a single grant project for a one 
year period. The budget period for the project will begin September 1, 
1995.

Funding Limits

    The award is limited to a maximum total amount of $500,000 (direct 
and indirect costs), depending on the availability of funds, which are 
subject to reductions in the appropriated amounts.
    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. The 
successful applicant will be required to share in the costs of the 
project by providing equipment, personnel, building space, indirect 
costs, other in-kind contributions, or cash.

DATES: Applications for the grant must be received by the close of 
business on May 2, 1995.
    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 AND FURTHER INFORMATION: Requests for grant application kits 
and for technical or programmatic information on this announcement 
should be directed to Carole Mintzer, Office of Rural Health Policy, 
5600 Fishers Lane, Room 9-05, Rockville, MD 20857, 301-443-0835, 
[email protected]. Requests for 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).

SUPPLEMENTARY INFORMATION:

Program Objectives

    The purpose of the grant 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. The grant will be awarded for implementing and operating 
a telemedicine system that links a multi-specialty entity 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 grant 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 grant 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, 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. The 
consultation may be interactive or asynchronous (e.g. store and forward 
technology).
    In order to compete for this grant, 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 
staffed beds), a rural primary care clinic or practitioner office. 
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, 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 or formal written agreement; (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.
    Applicants must monitor their own performance and be willing and 
able 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. 
[[Page 6140]] 
    The project, at a minimum, must be able to provide 
teleconsultations in the following specialty services:
    Teleradiology, cardiology, dermatology, mental health and/or 
substance abuse, obstetrics and gynecology, orthopedics, subspecialties 
of pediatrics, and stabilization of trauma patients. Applicants may 
propose to provide teleconsultations for additional services, such as 
physical therapy, speech therapy, diabetic counseling, dentistry, or 
otolaryngology.
    This grant 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 that 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 
for equipment placed in rural communities and for costs incurred in 
rural communities, including salaries, maintenance of equipment, and 
transmission costs.

Eligible Applicants

    The demonstration grant award will be made only to an entity 
located in the western third of the State of Nebraska. The entity can 
be either (1) a health care provider that is a member of a telemedicine 
network serving rural western Nebraska, or (2) a consortium of 
providers that are members of a telemedicine network serving rural 
western Nebraska. The applicant must be a legal entity capable of 
receiving Federal grant funds. The grant recipient can be a public 
(non-Federal) or private nonprofit or for-profit 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 be located in the western third of 
Nebraska, all of which is defined by OMB as a non-metropolitan 
statistical area.

Review Consideration

    Grant applications will be evaluated on the basis of the following 
criteria:

    (1) 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, as evidenced by the strength of the contractual 
arrangements among the members of the telemedicine network.
    (2) Demonstrated ability to monitor the performance of the 
project, collect data, and participate in an evaluation of 
telemedicine.
    (3) Demonstrated capability, experience, and knowledge by the 
applicant and other network members to carry out the project.
    (4) Reasonableness of the budget proposed for the project.
    (5) Level of local commitment and involvement with the project, 
as evidenced by the extent of cost participation by the applicant 
and/or other organizations, letters of support, and the feasibility 
of plans to sustain the project after Federal grant support has 
ended.
    (6) Extent to which the applicant has justified and documented 
the need(s) for the project, developed measurable goals and 
objectives for meeting the need(s), and designed a project that 
could be replicated in rural areas with similar needs and 
characteristics.

Other Information

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

Public Health System Impact Statement

    This grant 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 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 of local health agencies.

Executive Order 12372

    This grant program 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, West Tower, 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.

    This is intended to be a one-time program. Therefore, a Catalog 
of Federal Domestic Assistance number has not been requested.

    Dated: January 26, 1995.
Ciro V. Sumaya,
Administrator.
[FR Doc. 95-2432 Filed 1-31-95; 8:45 am]
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