[Federal Register Volume 61, Number 40 (Wednesday, February 28, 1996)]
[Notices]
[Pages 7525-7527]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-4477]



-----------------------------------------------------------------------


DEPARTMENT OF HEALTH AND HUMAN SERVICES

Special Projects of National Significance; Integrated Service 
Delivery Models

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of Availability of Funds.

-----------------------------------------------------------------------

SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that applications will be accepted for fiscal year (FY) 1996 
Grants for Special Projects of National Significance (SPNS) funded 
under the authority of Section 2618(a) of the Public Health Service 
Act, as established by the Ryan White Comprehensive AIDS Resources 
Emergency (CARE) Act of 1990, Public Law 101-381, dated August 18, 
1990. This announcement solicits applications addressing integrated 
service delivery for persons with HIV disease. Under this announcement, 
applicants must respond to one of the two categories delineated in the 
section entitled, ``Description of Categories''. Applicants can apply 
for project periods of up to 5 years. The SPNS program, in 
collaboration with the SPNS funded HIV Evaluation Technical Assistance 
Center grantee, will provide technical assistance and support for 
project's program evaluation studies.
    This program announcement is subject to the appropriation of funds. 
Applicants are advised that this program announcement is a contingency 
action being taken to assure that should funds become available for 
this purpose, they can be awarded in a timely fashion consistent with 
the needs of the program as well as to provide for an even distribution 
of funds throughout the fiscal year. At this time, given a continuing 
resolution and the absence of FY 1996 appropriations for the Ryan White 
CARE Act programs, the amount of available funding for these specific 
grant programs cannot be estimated.
    The SPNS program is designed to demonstrate and evaluate innovative 
and potentially replicable HIV service delivery models. The authorizing 
legislation specifies three SPNS program objectives: (1) To assess the 
effectiveness of particular models of care; (2) to support innovative 
program design; and (3) to promote replication of effective models.

DATES:

Notification

    In order to allow HRSA to plan for the Objective Review Process, 
applicants are encouraged to contact the grants office in writing to 
notify HRSA of their intent to apply. This notification serves to 
inform HRSA of the anticipated number of applications and the category 
(and sub-category, if applicable) in which applications are being 
submitted. If notification is offered, it should be received within 30 
days after publication of the Notice of Availability of Funds in the 
Federal Register. The address is: Grants Management Branch; Bureau of 
Health Resources Development; Health Resources and Services 
Administration; Room 7-15; Rockville, MD 20857.

Application

    Applications for these announced grants must be received in the 
Grants Management Branch by the close of business May 28, 1996, to be 
considered for competition. Applications will meet 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 
submission to the objective review panel. A legibly dated receipt from 
a commercial carrier or U.S. Postal Service will be accepted as proof 
of timely mailing. Applications received after the deadline will be 
returned to the applicant.

ADDRESSES: Grant applications, guidance materials, and additional 
information regarding business, administrative, and fiscal issues 
related to the awarding of grants under this Notice may be requested 
from Mr. Neal Meyerson, Grants Management Branch, Bureau of Health 
Resources Development, Health Resources and Services Administration, 
5600 Fishers Lane, Room 7-15, Rockville, MD, 20857. The telephone 
number is (301) 443-2280 and the FAX number is (301) 594-6096. 
Applicants for grants will use Form PHS 5161-1, approved under OMB 
Control No. 0937-0189. Completed applications should be sent to the 
Grants Management Branch.

FOR FURTHER INFORMATION CONTACT: Additional technical information may 
be obtained from the SPNS Branch, Office of Science and Epidemiology, 
Bureau of Health Resources Development, Health Resources and Services 
Administration, 5600 Fishers Lane, Room 7A-07, Rockville, MD 20857. The 
telephone number is (301) 443-9976 and the FAX number is (301) 594-
2511.

HEALTHY PEOPLE 2000 OBJECTIVES: The Department of Health and Human 
Services (DHHS) urges applicants to address specific objectives of 
Healthy People 2000 in their work plans. 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 200402-9325 (Telephone 202-783-3238).

SUPPLEMENTARY INFORMATION:

Background and Objectives

    The SPNS program endeavors to advance knowledge and skills in HIV 
services delivery, stimulate the design of innovative models of care, 
and support the development of effective delivery systems for these 
services. SPNS accomplishes its purpose through funding and technical 
support of innovative HIV service delivery models. For purposes of this 
announcement, models seeking SPNS support must address one of the two 
categories described below.
    In establishing the current special project categories, 
consideration was given to priority service areas identified in the 
SPNS concept paper, Future Directions: Increasing Knowledge about 
Health and Support Service Delivery to People with HIV Disease. This 
document was developed through interviews with and written comments 
from, key HRSA staff and experts inside and outside the U.S. Public 
Health Service, following a review of relevant HIV-related service 
delivery, research, evaluation, policy and planning documents. 
Consideration was also given to recommendations expressed during the 
1995 White House Conference on HIV and AIDS. Participants in the White 
House Conference and others recommended that collaborative efforts be 
made by the Departments of Health and Human Services and Housing and 
Urban Development to integrate funding streams for projects that 
address the needs of clients with multiple diagnoses.
    The SPNS program supports innovative projects for which 
implementation, utilization, costs, and outcomes can be evaluated 
rigorously. 

[[Page 7526]]
Proposals will be expected to adequately define and justify the need, 
innovative nature, and evaluation methodology of the proposed model of 
services. These funds should be used to create and/or evaluate models 
of care that would likely not exist nor be evaluated without SPNS 
support, or that would extend the care model to previously underserved 
or unserved populations defined either geographically or 
demographically.
    SPNS funds cannot be used for expenses related to the provision of 
medical care; supportive services; or any other expenses currently 
reimbursed, subsidized or eligible for reimbursement through third 
party payers, grants awarded under Titles I-IV of the Ryan White CARE 
Act, or other grant and foundation sources.

Description of Categories

    The Special Project Categories for FY 1996 will support the 
development and evaluation of models of care that address the formal 
linkage and integration of HIV ambulatory medical care (including 
primary medical care, mental health, substance abuse treatment and/or 
other critical HIV services).
    Applications will be accepted that propose to demonstrate and 
evaluate:

Category A--Models of Integrated Service Delivery for Persons with HIV 
Disease

    The formal linkage and integration of mental health, substance 
abuse treatment, rehabilitation and/or other critical HIV services with 
HIV ambulatory medical care (such as primary medical care and/or home/
health care) in new or existing projects. Projects may provide 
comprehensive services to people with HIV disease in locations or 
facilities or clinics that serve only people with HIV disease or those 
that also care for people who do not have HIV disease. Where 
applicable, project evaluations should compare client and provider 
outcomes and satisfaction with care for HIV infected clients receiving 
care in HIV specific provider sites as compared to HIV infected clients 
receiving care in non-HIV specific settings.
    Applicants for this category must address one of the following sub-
categories:
    (1) Coordinated delivery of HIV health and support services to 
specified transient, homeless, migrant, immigrant or mobile populations 
to ensure the delivery of a comprehensive continuum of care throughout 
the course of HIV infection and disease;
    (2) Delivery of comprehensive health and support services to Native 
Americans (such as American Indians, Alaskan Natives or Native 
Hawaiians) through a network of providers experienced in caring for 
Native American communities; or
    (3) Development of an integrated system of HIV ambulatory medical 
care services for an unserved or underserved population group that is 
experiencing a significant barrier(s) to care (e.g., ethnic and 
language minorities, visually or hearing impaired communities, the 
severely and persistently mentally ill, rural communities, or others) 
that improves access to and retention in the health care delivery 
system.

Category B--The Multiple Diagnoses Initiative

    This initiative, a collaborative effort between the Departments of 
Health and Human Services (HHS) and Housing and Urban Development 
(HUD), is designed to develop and evaluate programs for the integration 
of medical, substance abuse, mental health services and other support 
services with housing assistance for homeless persons with HIV/AIDS and 
a serious mental illness and/or alcohol or substance abuse problems. 
The collaboration targets ``on the street'' homeless persons who 
currently do not have a place to live. This would include an innovative 
strategy for developing an integrated system of outreach, needs 
assessment, comprehensive health and other support services and various 
types of transitional and permanent housing which has the potential for 
replication. Related assistance is being announced under the Special 
Projects of National Significance component of HUD's Housing 
Opportunities for Persons with AIDS (HOPWA) program. For further 
information about HUD assistance, please contact Fred Karnas, Office of 
HIV/AIDS Housing, Community Planning and Development, 451 Seventh 
Street, SW, Room 7154, Washington, DC, 20410-7000. The telephone number 
is 202-708-1934 and the FAX number is 202-708-1744.

Review Criteria

    Applications submitted to the SPNS program under this announcement 
will be reviewed and rated by an objective review panel. Criteria for 
the technical review of applications will include the following 
factors:
    Factor 1: Justification of Need (15 points) Adequacy of 
demonstrated knowledge of the local HIV service delivery system and the 
adequacy of the justification of need within the community and target 
population for the proposed integration model. The extent to which the 
applicant's justification of need goes beyond documenting the existence 
of an available population in need of HIV services and describes what 
is innovative about the proposed model, how this model will be of 
benefit to the population in need, and its potential to advance 
knowledge in the HIV service delivery field. The adequacy of the 
discussion about whether or not this or similar models have been 
evaluated in published literature or reports. The extent to which the 
applicant identifies past/existing/future systemic or programmatic 
issues that have contributed to a fragmented service delivery system 
and how this model will develop a more integrated system of care.
    Factor 2: Description of Proposed HIV Service Integration Model (25 
points) The extent of the feasibility and clarity of the description, 
appropriateness, innovative quality, and potential for evaluation, 
replication and dissemination of the proposed model. The amount of 
emphasis given to the definitive integration of services to ensure the 
delivery of a comprehensive spectrum of care to persons with HIV 
disease. The extent to which the identification of providers and 
services integrated by the model is described. The adequacy of the 
discussion of the rationale for the selection of providers and services 
integrated by the proposed model.
    Factor 3: Description of Program Plan (20 points) Comprehensiveness 
of the program plan as described in clearly stated goals, time-limited 
and measurable objectives for each goal, activities directly related to 
each objective, and a time line that shows the schedule of activities 
and production of materials that corresponds to milestones stated in 
the objectives and program evaluation. The extent to which the 
applicant demonstrates access to the proposed target population. The 
feasibility of the description of a process for maintaining client 
confidentiality throughout the project period.
    Factor 4: Description of Evaluation Plan (20 points) Thoroughness, 
feasibility and appropriateness of the project's evaluation design from 
a methodological and statistical perspective. The extent to which the 
design of the evaluation allows a generalized conclusion regarding the 
outcomes of the integration model and its suitability for replication. 
The adequacy of the plan to assess HIV-related health outcomes among 
the population serviced and followed, and 

[[Page 7527]]
the anticipated outcome impact from a systems level perspective.
    Factor 5: Description of Dissemination (10 points) The extent to 
which the applicant demonstrates past involvement with disseminating 
information about HIV service delivery by describing dissemination 
activities to date (e.g., presenting and publishing findings through 
reports and papers, training, or technical assistance). The adequacy 
and feasibility of the preliminary dissemination plan.
    Factor 6: Description of Organizational Capacity (10 points) 
Competency of the applicant organization in terms of fiscal, program 
management, and evaluation, as evidenced by (a) the consistency between 
the proposed level of effort and the budget justification; (b) skill 
level and time commitment required in the personnel specifications for 
program and evaluation staff; (c) the adequacy of resources proposed to 
conduct a quality evaluation of the project and dissemination of the 
project's findings; (d) the qualifications and experience of the 
proposed evaluation staff; and (e) appropriate confidential handling of 
clients' medical, social service, and epidemiological data. Extent of 
documentation demonstrating current and proposed coordination, formal 
collaboration, and specific linkages with related medical, health and 
support service activities within the project's catchment area.

Other Grant Information

Allowable Costs

    The basis for determining allocable and allowable costs to be 
charged to PHS grants is set forth in 45 CFR part 74, subpart Q and 45 
CFR part 92 for State, local or tribal governments. The four separate 
sets of cost principles prescribed for public and private non-profit 
recipients are OMB Circular A-87 for State, local or tribal 
governments; OMB Circular A-21 for institutions of higher education; 45 
CFR part 74, appendix E for hospitals; and OMB Circular A-122 for 
nonprofit organizations.

Reporting and Other Requirements

    A successful applicant under this notice will submit semi-annual 
activity summary reports in accordance with provisions of the general 
regulations which apply under 45 CFR part 74, subpart 74.51, 
``Monitoring and Reporting Program Performance,'' with the exception of 
State and local governments to which 45 CFR part 92, Subpart C 
reporting requirements apply. Also, grantees must be prepared to 
collaborate with other grantees on the design and implementation of 
project evaluations which may include multi-site evaluation studies.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements which have been approved by the Office of Management and 
Budget under No. 0937-0195. Under these requirements, any community-
based, non-governmental applicant must prepare and submit a Public 
Health System Impact Statement (PHSIS). The PHSIS is intended to keep 
State and local health officials apprised of proposed health services 
grant applications submitted from within their jurisdictions.
    Community-based, non-governmental applicants are required to 
submit, no later than the Federal due date for receipt of the 
application, the following information to the administrator of the 
State and local AIDS programs in the area(s) to be impacted by the 
proposal: (a) A copy of the face page of the application (SF424); and, 
(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; and, (3) a description of the 
coordination planned with the appropriate State or local health 
agencies. Copies of the letters forwarding the PHSIS to these 
authorities must be contained in the application materials submitted to 
this program.

Certification Regarding Environmental Tobacco Smoke

    The Public Health Service strongly encourages all grant and 
contract recipients to provide a smoke-free workplace and to promote 
the non-use of all tobacco products. In addition, Public Law 103-227, 
the Pro-Children Act of 1994, prohibits smoking in certain facilities 
(or in some cases, any portion of a facility) in which regular or 
routine education, library, day care, health care or early childhood 
development services are provided to children.

Executive Order 12372

    The Special Projects of National Significance Grant Program has 
been determined to be a program 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 Single Point of Contact 
(SPOC) in the State for the review. Applicants (other than federally 
recognized Indian tribes) 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.)

OMB Catalog of Federal Domestic Assistance

    Number for the Special Projects of National Significance is 93.928.

    Dated: February 14, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-4477 Filed 2-27-96; 8:45 am]
BILLING CODE 4160-15-P