[Federal Register Volume 60, Number 240 (Thursday, December 14, 1995)]
[Notices]
[Pages 64168-64174]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30417]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Rural Health Services Outreach Grant Program

AGENCY: Health Resources and Services Administration, PHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Office of Rural Health Policy, Health Resources and 
Services Administration (HRSA), announces that applications are being 
accepted for Rural Health Services Outreach Demonstration Grants to 
expand or enhance the availability of essential health services in 
rural areas. Grants for these projects are authorized under Section 301 
of the Public Health Service Act.
    This program announcement for the above stated program is subject 
to the appropriation of funds for this activity. Applicants are advised 
that this program announcement is a contingency action being taken to 
assure that should funds become available for this purpose, awards can 
be made in a timely fashion consistent with the needs of the program. 
At this time, given a continuing resolution and the absence of FY 1996 
appropriations for this program, the amount of funds available cannot 
be estimated.

NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2000: The Health Resources & 
Services Administration (HRSA) is committed to achieving the health 
promotion and disease prevention objectives of Healthy People 2000, a 
Public Health Service (PHS) national activity for setting priority 
areas. The Rural Health Services Outreach 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-

[[Page 64169]]
00473-1) through the Superintendent of Documents, Government Printing 
Office, Washington, DC 20402-9325 (Telephone (202) 783-3238).

AMOUNT AND DURATION OF GRANT AWARDS: Individual grant awards under this 
notice will be limited to a total amount of $300,000 (direct and 
indirect costs) per year. Applications for smaller amounts are 
encouraged. Applicants may propose project periods for up to three 
years, but the duration of projects is contingent upon the availability 
of funds. It is expected that the average grant award will be 
approximately $180,000 for the first year. However, applicants are 
advised that continued funding of grants beyond the one year period 
covered by this announcement is contingent upon the appropriation of 
funds for the program and assessment of grantee performance. No project 
will be supported for more than three years.

APPLICATION DEADLINE: Applications for the program must be received by 
the close of business on March 15, 1996. Completed applications must be 
sent to The Grants Management Officer, c/o Global Exchange, Inc., 7910 
Woodmont Avenue, Suite 400, Bethesda, Maryland 20814.
    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 legibly 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.
    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. To receive an 
application kit, contact The Grants Management Office, c/o Global 
Exchange, Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, Maryland 
20814 or, in the contiguous U.S., call 1-800/784-0345. Hawaii, Alaska, 
Puerto Rico, the Northern Mariana Islands, the Virgin Islands, Guam, 
American Samoa, the Compact of Free Association Jurisdictions of the 
Republic of the Marshall Islands, the Republic of Palau, and the 
Federated States of Micronesia should call 301/656-3100 COLLECT.

FOR FURTHER INFORMATION CONTACT: Information or technical assistance 
regarding business, budget, or financial issues should be directed to 
the Office of Grants Management, Bureau of Primary Health Care, Health 
Resources and Services Administration, 4350 East West Highway, 11th 
Floor, Bethesda, Maryland 20814, 301/594-4260. Requests for technical 
or programmatic information on this announcement should be directed to 
Eileen Holloran, Office of Rural Health Policy, Room 9-05, Parklawn 
Building, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 443-0835.

SUPPLEMENTARY INFORMATION:

Eligible Applicants

    The grant recipient must be a nonprofit or public entity which 
meets one of the three requirements stated below.
    (1) The applicant's central administrative headquarters where the 
grant will be managed is not located in a Metropolitan Statistical Area 
as defined by the Office of Management and Budget. A list of the cities 
and counties that are designated as Metropolitan Statistical Areas is 
included in the application kit. If your organization's central 
administrative headquarters is located in one of these areas, you are 
not eligible for the program unless you meet one of the other two 
criteria listed below.
    (2) Some Metropolitan Statistical Areas on the list are extremely 
large. We have divided these areas into rural and urban census tracts. 
Appendix I provides a list of these Metropolitan Statistical Areas and 
the rural census tracts in each area. If your central administrative 
headquarters is located within one of these census tracts, you are 
eligible for the program.
    (IF YOU ARE ELIGIBLE UNDER THIS CRITERION, YOU MUST LIST YOUR 
COUNTY AND CENSUS TRACT UNDER ITEM #8 ON THE FACE PAGE OF THE 
APPLICATION OR YOUR APPLICATION WILL BE RETURNED. If you do not know 
your census tract, Appendix II provides the telephone numbers for 
regional offices of the Census Bureau. You should call the appropriate 
office to determine your census tract.)
    (3) Your organization is constituted exclusively to provide 
services to migrant and seasonal farmworkers in rural areas and is 
supported under Section 329 of the Public Health Service Act. These 
organizations are eligible regardless of the urban or rural location of 
their administrative headquarters.
    In addition to meeting one of the above criteria, the applicant 
must be capable of receiving the grant funds directly and must have the 
capability to manage the project. This means that the applicant 
organization must be able to exercise administrative and program 
direction over the grant project; must be responsible for hiring and 
managing the project staff; must have the administrative and accounting 
capabilities to manage the grant funds; and must have some permanent 
staff at the time a grant award is made. Further, the applicant 
organization must have an Employer Identification Number from the 
Internal Revenue Service at the time of the grant award and other proof 
of organizational viability that may be requested by the Grants 
Management Office.
    Applicants from the 50 United States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana 
Islands, the Territories of the Virgin Islands, Guam, American Samoa, 
the Compact of Free Association Jurisdictions of the Republic of the 
Marshall Islands, the Republic of Palau, and the Federated States of 
Micronesia, are eligible to apply.
    Applications from organizations that do not meet one of the three 
requirements described above will not be reviewed.
    Current Rural Health Services Outreach grantees who are in the last 
year of their projects may not reapply for funds to support the same 
project. Any new proposal they submit must have a different focus from 
the project that is currently being funded.

Program Objectives

    The purpose of the program is to support projects that demonstrate 
new and innovative models of outreach and health care services delivery 
in rural areas that lack basic health services. Grants will be awarded 
either for the direct provision of health services to rural populations 
that are not currently receiving them, or to enable access to and 
utilization of existing services.
    Applicants may propose projects to address the needs of a wide 
range of rural population groups, including the poor, the elderly, the 
disabled, pregnant women, infants, adolescents, rural minority 
populations, and rural populations with special health care needs. 
Projects should be responsive to the special cultural and linguistic 
needs of specific populations.
    A central goal of the demonstration program is to develop new and 
innovative models for more effective integration and coordination of 
health services in rural areas. It is hoped that some of these models 
will prove significant in solving rural health problems throughout the 
country. In order to better integrate the provision of health services 
in rural areas, participation in the program requires 

[[Page 64170]]
the formation of consortium arrangements among three or more separate 
and distinct entities to carry out the demonstration projects.
    A consortium must be composed of three or more health care 
organizations, or a combination of three or more health care and social 
service organizations. At least one of the entities must be a health 
care service delivery organization. Individual members of a consortium 
might include such entities as hospitals, public health agencies, Area 
Health Education Centers, home health providers, mental health centers, 
substance abuse service providers, rural health clinics, social service 
agencies, health profession schools, local school districts, emergency 
service providers, community and migrant health centers, civic 
organizations, etc. Although applicants for the program must be 
nonprofit or public entities, other consortium members may be for-
profit organizations.
    The roles and responsibilities of each member organization must be 
clearly defined and each must contribute significantly to the goals of 
the project. The process used to ensure compliance with the consortium 
requirement includes two steps: (1) making sure that at least three 
organizations, including the applicant, are identified, and that each 
is a separate legal entity, and (2) ensuring that each member plays a 
substantial part in accomplishing the objectives of the project.
    Applicants are encouraged to develop projects to address specific 
areas of need in their communities. Need can be established through a 
formal needs assessment or by population specific demographic data. The 
following are examples of project focus areas that can be supported 
through this program:
    1. Projects that bring ambulatory and mental health care to 
unserved or underserved rural areas or populations. The HRSA has a 
special priority to establish primary care programs along the U.S./
Mexican border.
    2. Projects that provide, or make possible the provision, of 
emergency medical services within rural areas that lack these services.
    3. The creation of new integrated networks of providers to deliver 
ambulatory care when such networks appear likely to improve access to 
health care or its quality. The HRSA is especially interested in 
networks that may become a part of managed care systems in rural areas.
    4. Projects that provide services that enable rural populations to 
better utilize existing health services, including those involving the 
use of community outreach workers.
    5. Projects that provide training for health care professionals and 
workers, including community outreach workers, when such training may 
be demonstrated to be likely to lead to higher quality services or more 
accessible services in rural areas.
    6. Projects that enhance the health and safety of farmers, farm 
families, and migrant and seasonal farm workers through direct 
services.
    7. Projects that address the needs of rural minority populations.
    8. Projects that train rural people in disease prevention and 
health promotion, when such training addresses critical needs of the 
area.
    9. Telecommunication and telemedicine projects.
    10. Projects on adolescent health and on school-based programs.
    The focus areas listed above are examples only. All projects must 
address the demonstrated needs of the community.

Review Consideration

    Grant applications will be evaluated on the basis of the following 
criteria:
    1. The extent to which the applicant has documented and justified 
the need(s) for the proposed project.
    2. The extent to which the applicant has proposed new approaches 
that will meet the health care needs of the community and has developed 
measurable goals and objectives for carrying out the project.
    3. The extent to which the applicant has clearly defined the roles 
and responsibilities of each member of the consortium and demonstrated 
the experience and expertise needed to manage the project.
    4. The level of local commitment and involvement with the project, 
as evidenced by: (1) the extent of cost participation on the part of 
the applicant, members of the consortium, and other organizations; (2) 
letters of support from community leaders and organizations; and, (3) 
the feasibility of plans to sustain the project after federal grant 
support is ended.
    5. The reasonableness of the budget that is proposed for the 
project.
    6. The extent to which the applicant has developed a realistic and 
workable plan for evaluating the project and for disseminating 
information about the project.

Geographic Considerations

    The HRSA hopes to expand the outreach program into geographic areas 
not currently served by the program. Consequently, HRSA will consider 
geographic coverage when deciding which approved applications to fund.

Other Information

    Grantees will be required to use at least 85 percent of the total 
amount awarded for outreach and care services, as opposed to 
administrative costs. At least 50 percent of the funds awarded must be 
spent in rural areas. This is a demonstration program that will not 
support projects that are solely or predominantly designed for the 
purchase of equipment or vehicles. The purchase of equipment and 
vehicles may not represent more than 40 percent of the total federal 
share of a proposal. Grant funds may not be used for purchase, 
construction or renovation of real property or to support the delivery 
of inpatient services.
    Applicants are advised that the entire application may not exceed 
70 pages in length including the project and budget narratives, face 
page, all forms, appendices, attachments and letters of support. 
Applications that exceed the 70 page limit will not receive 
consideration. All applications must be typewritten and legible. 
Margins must be no less than \1/2\ inch 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 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 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 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.

Executive Order 12372

    The Rural Health Services Outreach Grant Program has been 
determined to 

[[Page 64171]]
be a program which 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 Harriet Green, Office of 
Grants Management, Bureau of Primary Health Care, 4350 East West 
Highway, 11th Floor, Bethesda, Maryland 20814, (301) 594-4260. The due 
date for state process recommendations is 60 days after the application 
deadline (May 15, 1996) for competing applications. The granting agency 
does not guarantee to ``accommodate or explain'' state process 
recommendations it receives after that date. (See Part 148 of the PHS 
Grants Administration Manual, Intergovernmental Review of PHS Programs 
under Executive Order 12372 and 45 CFR Part 100 for a description of 
the review process and requirements.

State Offices of Rural Health

    Applicants should notify their State Office of Rural Health of 
their intent to apply for this grant program. The State Office can 
provide information and technical assistance. A list of State Offices 
of Rural Health will be provided with the application kit.

OMB Catalog of Federal Domestic Assistance number is 93.912

    Dated: December 7, 1995.
Ciro V. Sumaya,
Administrator.

Appendix I

*Census tract numbers are shown below each county name.
    To be eligible under criterion #2 your organization's central 
administrative headquarters must be located in one of the census 
tracts that is listed below your county. The county name and the 
census tract number must be included in section #8 on the face page 
of the 424 application.

State

County

Census 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

[[Page 64172]]

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 

[[Page 64173]]

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
01050106
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 

[[Page 64174]]


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--617-424-0501
    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--708-562-1350
    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--313-259-0056
    Michigan, Ohio, West Virginia
Kansas City, KS--913-551-6711
    Arkansas, Iowa, Kansas, Missouri, New Mexico, Oklahoma
Los Angeles, CA--818-904-6339
    California
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. 95-30417 Filed 12-13-95; 8:45 am]
BILLING CODE 4160-15-P