[Federal Register Volume 61, Number 55 (Wednesday, March 20, 1996)]
[Notices]
[Pages 11424-11426]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-6664]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

The Ryan White Comprehensive AIDS Resources Emergency Act of 
1990; Availability of Funds for Early Intervention Services

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Availability of Funds for Grants To Provide Outpatient Early 
Intervention Services with Respect to HIV Disease.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that applications will be accepted for fiscal year (FY) 1996 
discretionary grants to provide outpatient early intervention services 
including primary care services with respect to human immunodeficiency 
virus (HIV) disease.
    These grants are awarded under the provisions of subpart II and 
subpart III of part C of title XXVI of the Public Health Service (PHS) 
Act, as amended by the Ryan White Comprehensive AIDS Resources 
Emergency (CARE) Act of 1990, Public Law 101-381 (42 U.S.C. 300ff-51--
300ff-67).
    This program announcement is subject to the final action on the 
appropriation of funds. At this time, given the continuing resolutions 
and the absence of a final FY 1996 appropriation for Ryan White Title 
III(b) programs, the specific amount available is not known.
    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. This grant program is related 
to the objectives cited for special populations, particularly people 
with low income, minorities, and the disabled, which constitute a 
significant portion of the homeless population. 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 20402-9325 (telephone 202 783-3238).
    PHS strongly encourages all grant and contract recipients to 
provide a smoke-free workplace and 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.

DUE DATES: Applications are due on June 1, 1996. Applications will be 
considered to have met the deadline if they are: (1) received on or 
before the deadline date; or (2) postmarked on or before the 
established deadline date and received in time for orderly processing. 
Applicants should request a legibly dated U.S. Postal Service postmark 
or obtain a legibly dated receipt from a commercial carrier or U.S. 
Postal Service. Private metered postmarks are not acceptable as proof 
of timely mailing. Applications received after the announced closing 
date will not be considered for funding.

ADDRESSES: Application kits (Form PHS 5161-1) with revised face sheet 
DHHS Form 424, as approved by the Office of Management and Budget under 
control number 0937-0189 may be obtained from, and completed 
applications should be mailed to, Bureau of Primary Health Care (BPHC) 
Grants Management Officer (GMO), c/o Houston Associates, Inc., 1010 
Wayne Avenue, Suite 1200, Silver Spring, MD 20901 (telephone 1-800-523-
2192; FAX 301-523-2193). The Office of Grants Management can provide 
assistance on business management issues. The BPHC Office of Grants 
Management is located at 4350 East West Highway, Bethesda, MD 20814 
(telephone 301-594-4235).

FOR FURTHER INFORMATION CONTACT: For general program information and 
technical assistance, contact Joan Holloway, Director, Division of 
Programs for Special Populations, Bureau of Primary Health Care (BPHC), 
at 4350 East-West Highway, Bethesda, Maryland 20814 (telephone 301-594-
4444).

SUPPLEMENTARY INFORMATION:

Number of Awards

    It is anticipated that should sufficient funds become available, 
approximately 50 competing grants may be awarded to organizations to 
provide early intervention services with respect to HIV. These grants 
may range from approximately $100,000 to approximately $500,000 and be 
made for a maximum of three years. Continuation awards for any future 
years will be made subject to the availability of funds and 
satisfactory performance in past budget years toward meeting the goals 
and objectives of the project.

Eligible Applicants

    Eligible applicants are public entities and nonprofit private 
entities that are: migrant health centers under Section 329 of the PHS 
Act; community health centers under Section 330 of the PHS Act; health 
care for the homeless grantees under Section 340 of the PHS Act; family 
planning grantees under Section 1001 of the PHS Act other than States; 
comprehensive hemophilia diagnostic and treatment centers; federally-
qualified health centers under section 1905(1)(2)(B) of the Social 
Security Act; or public and private nonprofit entities that currently 
provide comprehensive primary care services to populations at risk of 
HIV disease.
    Both existing Title III(b) grantees whose project periods end 
September 30, 1996 and new applicants that meet eligibility 
requirements may apply.

Project Requirements

    Funding under this grant program is intended to increase the 
capacity and accessibility of the specified entities to offer a higher 
quality and a broader scope of HIV-related early intervention services 
to a greater number of people in their service areas with or at risk 
for HIV infection. The program must meet the conditions specified in 
the statute and provide the services specified in the statute (sections 
2651, 2661 and 2662 of the Public Health Service Act). In addition, the 
program may provide certain optional services.
    The required services to be provided under this grant are:
     Comprehensive individual counseling, including counseling 
of pregnant women, regarding HIV disease according to specific 
statutory mandates for the content and conduct of pretest counseling, 
counseling of those with negative test results, counseling of those 
with positive results, with attention to the appropriate setting for 
all counseling;
     Testing individuals with respect to HIV disease, in 
laboratories certified by the Clinical Laboratories Improvement 
Amendments, including tests to confirm the presence of the disease, 
tests to diagnose the extent of the deficiency in the immune system, 
and tests to provide information on appropriate therapeutic measures 
for preventing and treating the deterioration of the immune system and

[[Page 11425]]

for preventing and treating conditions arising from the disease;
     Referral to appropriate providers of health and support 
services, including, as appropriate to entities funded under parts A 
and B of title XXVI of the PHS Act, to biomedical research facilities, 
community-based organizations or other entities that offer experimental 
treatment for HIV disease, and to grantees under section 2671 for the 
care of pregnant women;
     Other clinical and diagnostic services regarding HIV 
disease, and periodic medical evaluations of individuals with the 
disease; and
     Providing therapeutic measures for preventing and treating 
the deterioration of the immune system and for preventing and treating 
conditions arising from the disease.
    Optional services that may be included if they can be shown to be 
essential to the delivery of care are:
     Outreach, case management, and counseling for eligibility 
for other health services.
    Applicants, or providers acting under an agreement with the 
applicant, must be participating and qualified providers under the 
State Medicaid plan approved under title XIX of the Social Security 
Act, unless the participation agreement has been waived by the 
Secretary. A waiver procedure is available from BPHC. Grantees are 
required to maximize service reimbursements from private insurance, 
Medicare, other Federal programs, and other third-party payment 
sources.

Other Grant Requirements

    The applicant must agree that the services provided will conform to 
the assurances and agreements required under the statute that:
     The applicant will participate in an HIV care consortium 
established pursuant to part B, title XXVI, if such a consortium 
exists.
     Hemophilia services will be provided through the network 
of regional comprehensive hemophilia diagnostic and treatment centers.
     The applicant will ensure confidentiality of patient 
information.
     Testing will be provided only after obtaining a statement 
that the testing is done after counseling has been conducted and that 
the decision of the individual to undergo testing is voluntarily made.
     Opportunities for anonymous testing will be provided.
     Individuals seeking services will not have to undergo 
testing as a condition of receiving other health services.
     A sliding fee schedule which conforms to the requirements 
at *section 2664(e) of the PHS Act will be utilized.
     Funds will not be expended for services covered, or which 
could reasonably be expected to be covered, under any State 
compensation program, insurance policy, or under any Federal or State 
health benefits program, or by an entity that provides health services 
on a prepaid basis.
     Funds will be expended only for the purposes awarded, and 
such procedures for fiscal control and fund-accounting, as may be 
necessary, will be established.
     Counseling programs shall be designed to reduce exposure 
to, and transmission of HIV disease by providing accurate information; 
and shall provide information on the health risks of promiscuous sexual 
activity and injecting drug use.
     No more than 5 percent of the grant funds may be expended 
for administrative expenses. Funds may not be expended for 
construction, inpatient care, residential care, or cash payments to 
recipients of services.
     The HIV Client and Program Profile, which has been 
formally established as the Minimum Data Set (MDS) for BPHC, will be 
submitted annually. (Approved under the Paperwork Reduction Act, OMB 
No. 0915-0158.)
    A review of applications may take place to screen out new 
application(s) which should not be forwarded to the objective review 
committee because the above-mentioned requirements have not been met.

Criteria for Evaluating Applications

    These competitive applications for grant support will be reviewed 
based upon the following evaluation criteria:
     The need in the community, based on the 2-year period 
preceding the proposed grant period, for additional preventive and 
primary care services to those at risk for HIV infection, including 
women, children, and minorities, and to persons with HIV infection; 
barriers to meeting those needs within the existing service provider 
system; and other information (e.g., epidemiological and health 
resources data) that makes a compelling case for the grant requested as 
specified in section 2653 of the PHS Act.
     The extent of the applicant's role within the community in 
addressing the unmet needs for delivery of HIV primary care services to 
the targeted populations.
     The degree to which the proposed budget is appropriate to 
the program plan and the degree to which coordination with other 
funding sources is documented.
     Comprehensiveness of the existing, plus proposed, scope of 
counseling and testing, referral, primary care prevention, diagnostic 
and treatment services, and optional outreach, case management, or 
eligibility assistance services provided by the applicant; and 
development of mechanisms to assure continuity of primary care for 
persons living with HIV infection.
     The applicant's demonstrated efforts related to 
implementation of the HRSA Program Advisory, ``ZDV Therapy for Reducing 
Perinatal HIV: Implementation in HRSA Funded Programs.''
     Extent of active inclusion of people living with HIV 
disease in program planning or program implementation or program 
evaluation or formal advisory activities.
     Evidence of the provision of comprehensive oral health 
services (diagnostic, preventive, and therapeutic) as an integral part 
of the applicant's HIV early intervention program.
     Extent to which actions taken assure effective 
collaboration with city/county/State health department HIV prevention 
activities supported by the Centers for Disease Control and Prevention, 
and with State Care Consortia funded under section 2613 of the PHS Act; 
extent to which efforts are consistent with priorities of the HIV 
Planning Council in the cities funded under Title XXVI of the PHS Act, 
and with programs funded by other PHS agencies.
     The adequacy and completeness of the program evaluation 
plan, and the relationship of the evaluation plan to the goals and 
objectives of the proposed program, so that effectiveness can be 
measured.
    IN ADDITION, FOR PROJECT PERIOD RENEWALS: The degree to which the 
grantee succeeded in accomplishing the goals and objectives in the 
preceding project period, including the extent to which HIV primary 
care services were integrated into the applicant's overall primary care 
program; and a record of compliance with reporting requirements in 
effect during that period.
    IN ADDITION, FOR NEW APPLICANTS: demonstrated ability of the 
applicant organization to carry out the proposed program, including the 
extent to which the proposed key clinical staff have had prior 
experience in the provision of clinical care for individuals with HIV 
infection.

[[Page 11426]]

Planning Grants

    In the event that an amendment to the Ryan White CARE Act 
authorizing planning grants is enacted before the application due date 
of June 1, applications will be accepted for fiscal year (FY) 1996 
planning grants to develop a system of care to provide outpatient early 
intervention services including primary care services with respect to 
human immunodeficiency virus (HIV) disease. Subject to the availability 
of funds, it is anticipated that approximately 10 grants ranging from 
approximately $25,000 to $50,000 each may be awarded. The awarding of a 
planning grant will range from one to three years and will not, in any 
way, commit the PHS to support the applicant for additional planning 
grants or for future operational funding.

Eligible Applicants for Planning Grants

    Applicants for planning grants must be public entities and 
nonprofit private entities that are: migrant health centers under 
Section 329 of the PHS Act; community health centers under Section 330 
of the PHS Act; health care for the homeless grantees under Section 340 
of the PHS Act; family planning grantees under Section 1001 of the PHS 
Act other than States; comprehensive hemophilia diagnostic and 
treatment centers; federally qualified health centers under section 
1905(1)(2)(B) of the Social Security Act; or public and private 
nonprofit entities that currently provide comprehensive primary care 
services to populations at risk of HIV disease. The applicant must be 
located in a rural or underserved community where emerging or ongoing 
HIV issues have not been adequately addressed.

Project Requirements for Planning Grants

    Funding under this grant program is intended to increase the 
capacity and accessibility of the specified entities to offer a higher 
quality and a broader scope of HIV-related early intervention services 
to a greater number of people in their service areas who are at risk of 
HIV infection. The program must propose to address the requirements for 
the Ryan White Early Intervention Services Program, as outlined above, 
and as specified in the statute and provide the services specified in 
the statute (sections 2651, 2661 and 2662 of the Public Health Service 
Act).\1\
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    \1\ These references will be clarified in the program guidance 
document.
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Criteria for Evaluating Applications for Planning Grants

    These competitive applications for grant support will be reviewed 
based upon the following evaluation criteria:
     The need in the community, based on the 2-year period 
preceding the proposed grant period, for additional preventive and 
primary care services to those at risk for HIV infection, including 
women, children, and minorities, and to persons with HIV infection; 
barriers to meeting those needs within the existing service provider 
system; and other information (e.g., epidemiological and health 
resources data) that makes a compelling case for the grant requested.
     The applicant's proposed role within the community in 
addressing the unmet needs for delivery of HIV primary care services to 
the targeted populations.
     The degree to which the proposed budget is appropriate to 
the program plan and the degree to which coordination with other 
funding sources is documented.
     The degree to which the applicant proposes to include 
people living with HIV disease in program planning or program 
implementation or program evaluation or formal advisory activities.
     The degree to which the applicant proposes effective 
collaboration with city/county/State health department HIV prevention 
activities supported by the Centers for Disease Control and Prevention, 
with State Care Consortia funded under Section 2613 of the PHS Act, 
with the HIV Planning Council in the cities funded under Title XXVI of 
the PHS Act, and with programs funded by other PHS agencies.
     The adequacy and completeness of the program evaluation 
plan, and the relationship of the evaluation plan to the goals and 
objectives of the proposed program, so that effectiveness can be 
measured.

Other Award Information

    Public Health System Reporting Requirements: Under these 
requirements (approved by the Office of Management and Budget 0937-
0195), 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:
    (1) A copy of the face page of the application (SF 424).
    (2) A summary of the project, not to exceed one page, which 
provides:
    (a) A description of the population to be served,
    (b) A summary of the services to be provided, and
    (c) A description of the coordination planned with the appropriate 
State and local health agencies.
    The Program to Provide Outpatient Early Intervention Services with 
Respect to HIV Disease has been determined to 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. 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 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 of each affected State. The due date for State process 
recommendations is 60 days after the appropriate deadline dates. The 
BPHC does not guarantee that it will accommodate or explain its 
responses to State process recommendations received after the date. 
(See ``Intergovernmental Review of Federal Programs'', Executive Order 
12372, and 45 CFR part 100 for a description of the review process and 
requirements.)

    The OMB Catalog of Federal Domestic Assistance number for this 
program is 93.918.

    Dated: March 14, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-6664 Filed 3-19-96; 8:45 am]
BILLING CODE 4160-15-P