[Federal Register Volume 61, Number 120 (Thursday, June 20, 1996)]
[Notices]
[Pages 31537-31539]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-15788]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Special Project Grants; Maternal and Child Health (MCH) Services; 
Community Integrated Service Systems (CISS) Set-Aside Program

AGENCY: Health Resources and Services Administration (HRSA), HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The HRSA announces that applications will be accepted for 
fiscal year (FY) 1996 funds for Maternal and Child Health (MCH) 
Community Integrated Service Systems grants to support strategies for 
reducing infant mortality and improving the health of mothers and 
children through development and expansion of successful community 
integrated service systems. These systems are public-private 
partnerships of community health and other related organizations and 
individuals working collaboratively to use community resources to 
address community-identified health problems. Awards are made under the 
program authority of section 502(b)(1)(A) of the Social Security Act, 
the CISS Federal Set-Aside Program. Within the HRSA, CISS projects are 
administered by the Maternal and Child Health Bureau (MCHB).
    Of the approximately $9.5 million available for CISS activities in 
FY 1996, about $7.0 million will be available to support approximately 
132 new and competing renewal projects at an average of about $53,000 
per award for a one-year period under the MCH CISS Federal Set-Aside 
Program. The remaining funds will be used to continue existing CISS 
projects and for other activities in support of overall CISS program 
goals. The actual amounts available for awards and their allocation may 
vary, depending on unanticipated program requirements and the volume 
and quality of applications. Awards are made for grant periods which 
generally run from 1 up to 4 years in duration. Funds for CISS awards 
are appropriated by Public Law 104-134.
    The Public Health Service (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. The MCH 
Block Grant Federal Set-Aside Program addresses issues related to the 
Healthy People 2000 objectives of improving maternal, infant, child and 
adolescent health and developing service systems for children with 
special health care needs. 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).
    The PHS strongly encourages all grant 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.

ADDRESSES: Grant application materials for CISS awards must be obtained 
from and submitted to: Chief, Grants Management Branch, Office of 
Operations and Management, Maternal and Child Health Bureau, Health 
Resources and Services Administration, Room 18-12, Parklawn Building, 
5600 Fishers Lane, Rockville, Maryland 20857, Attn: CISS, (301) 443-
1440. Applicants will use Form PHS 5161-1, approved by OMB under 
control number 0937-0189. You must obtain application materials by 
mail.
    Federal Register notices and application guidance for MCHB programs 
are available on the World Wide Web via the Internet at address: http:/
/www.os.dhhs.gov/hrsa/mchb. Click on the file name you want to download 
to your computer. It will be saved as a self-extracting (Macintosh or) 
Wordperfect 5.1 file. To decompress the file once it is downloaded, 
type in the file name followed by a . The file will expand to a 
Wordperfect 5.1 file. If you have difficulty accessing the MCHB Home 
Page via the Internet and need technical assistance, please contact 
Linda L. Schneider at 301-443-0767 or ``[email protected]''.

DATES: The deadline for receipt of applications for Health Systems 
Development Grants for Child Care is August 1; the deadline for all 
other CISS grants covered by this announcement is July 22, 1996. 
Applications will be considered to have met 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 should request 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 or those sent 
to an address other than specified in the ADDRESSES section will be 
returned to the applicant.

FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic 
information from MCHB should be directed to Joe Zogby, Division of 
Maternal, Infant, Child and Adolescent Health, Maternal and Child 
Health Bureau, Health Resources and Services Administration, Room 18A-
39, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857, 
telephone (301) 443-4393. Requests for information concerning business 
management issues should be directed to Arlethia Dawson, Grants 
Management Specialist, Grants Management Branch, Maternal and Child 
Health Bureau, at the address listed in the ADDRESSES section above.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

    Public Law 101-239, the Omnibus Budget Reconciliation Act of 1989 
(OBRA 1989) provided for a new set-aside program under the MCH Block 
Grant that would be activated when the annual appropriation for Title V 
exceeds $600 million dollars. This has become known as the CISS 
program. The program seeks to reduce infant mortality and improve the 
health of mothers and children, including those living in rural areas 
and those having special health care needs, through project support for 
development and expansion of strategies which have proved successful

[[Page 31538]]

in helping communities to achieve integrated service systems.
    OBRA 89 also provided the conceptual framework for strengthening 
Federal-State partnerships under the MCH Block Grant. States are now 
expected to work with their Federal and local partners to promote 
development of comprehensive, community-based systems of health and 
related services which can assure family-centered, culturally 
competent, coordinated care for children and their families.
    CISS Phase I (FY 92-95) featured support of demonstrations of one 
or more Congressionally-designated service delivery strategies: home 
visiting activities; providers participation in publicly funded 
programs; one stop shopping services integration projects; not-for-
profit hospital/community based initiatives; MCHB projects serving 
rural populations and outpatient and community based program 
alternatives to inpatient institutional care. These service delivery 
demonstrations served as focal points or platforms from which linkages 
were established with a variety of agencies, laying the foundation for 
a local system of delivery of services.
    Initial CISS grants funded in FY 1992 were required to use at least 
one of the above-listed six strategies to achieve program objectives. 
In FY 1993, CISS grants were directed toward developing and/or 
expanding successful community integrated service systems using at 
least one of the six strategies. Priority was given to projects which 
could demonstrate a high likelihood of having continuing support beyond 
the federal grant period and strong community based public/private 
organizational collaboration, including participation of the local 
county/municipal health departments, the State MCH and CSHCN programs, 
and, where they exist, community and migrant health centers.
    In FY 1994 and 1995 CISS grants supported Home Visiting for At-Risk 
Families (HVAF), in collaboration with the Administration for Children 
and Families' (ACF) Family Preservation and Support Program. The 
purpose of the CISS/HVAF was to assist State MCH programs to emphasize 
the home visiting model as an important component of care. The CISS/
HVAF grants were used to support development of an enhanced health 
component in the ACF's Five Year State Plans for Family Preservation 
and Family Support Services.
    Prior to establishing the CISS Phase II program priorities for FY 
1996 and beyond, feedback was solicited from members of the MCH 
community, the 41 current CISS grantees, and the MCH-ACF Technical 
Assistance Group, a working group of senior State and Federal-level 
child health, welfare, social services, and child care officials. 
Beginning with FY 1996, CISS Phase II will carry on with the local 
systems integration activities developed in Phase I, using a variety of 
approaches to complement the grants announced below.

Special Concerns

    In its administration of the MCH Services Block Grant, the MCHB 
places special emphasis on improving service delivery to women and 
children from racial and ethnic minority populations who have had 
limited access to care. This means that CISS projects are expected to 
serve and appropriately involve in project activities individuals from 
the populations to be served, unless there are compelling programmatic 
or other justifications for not doing so. The MCHB's intent is to 
ensure that project interventions are responsive to the cultural and 
linguistic needs of special populations, that services are accessible 
to consumers, and that the broadest possible representation of 
culturally distinct and historically underrepresented groups is 
supported through programs and projects sponsored by the MCHB. This 
same special emphasis applies to improving service delivery to children 
with special health care needs.
    In keeping with the goals of advancing the development of human 
potential, strengthening the Nation's capacity to provide high quality 
education by broadening participation in MCHB programs of institutions 
that may have perspectives uniquely reflecting the Nation's cultural 
and linguistic diversity, and increasing opportunities for all 
Americans to participate in and benefit from Federal public health 
programs, a funding priority will be placed on projects from 
Historically Black Colleges and Universities (HBCU) or Hispanic Serving 
Institutions (HSI) in both categories in this notice. An approved 
proposal from a HBCU or HSI will receive a 0.5 point favorable 
adjustment of the priority score in a 5 point range before funding 
decisions are made.

Evaluation Protocol

    An MCH discretionary project, including a CISS, is expected to 
incorporate a carefully designed and well planned evaluation protocol 
capable of demonstrating and documenting measurable progress toward 
achieving the project's stated goals. The protocol should be based on a 
clear rationale relating the project activities, the project goals, and 
the evaluation measures. Wherever possible, the measurements of 
progress toward goals should focus on health outcome indicators, rather 
than on intermediate measures such as process or outputs. A project 
lacking a complete and well-conceived evaluation protocol as part of 
the planned activities will not be funded.

Program Goal

    The goal of the CISS program is to enhance development of service 
systems at the community level that are capable of addressing the 
physical, psychological, social well-being, and related needs of 
pregnant women, infants, and children, including children with special 
health care needs and their families. CISS projects assist communities 
to better meet consumer-identified needs, fill gaps in services, reduce 
duplication of effort, coordinate activities, increase availability of 
services, improve efficiency, and enhance quality of care. Programs 
must be developed in collaboration and coordination with the State MCH 
Services Block Grant programs and State efforts in community systems 
development.

Award Categories

    Two categories of projects will be funded this year: (A) Community 
Organization Grants in 2 subcategories; and (B) Health System 
Development in Child Care Grants.

A. Community Organization Grants

    These grants will support community organization activities in two 
priority areas: (1) local level agencies; and (2) State MCH agencies. 
Funds may be used to hire staff to assist in consortium building and to 
function as community organizers, to help formulate a plan for 
integrated service systems, to obtain and/or provide technical 
assistance, and to convene community or State networking meetings for 
information dissemination and replication of systems integration 
programs.
1. Local Level Community Organization Grants
    Up to $2.5 million is available to support up to 50 new Local Level 
Community Organization Grants of up to $50,000 per year, beginning 
October 1, 1996. The project period is four years. This CISS program 
category provides direct support to individual communities for the 
purpose of arraying existing resources in the most beneficial fashion 
to serve the community's need. While not designed to support direct 
service delivery, these monies may be

[[Page 31539]]

used to modify functions of existing service organizations to better 
complement each other. The specific approach is at the discretion of 
each community. Because CISS projects are intended to facilitate the 
development of systems of services in communities, projects must be 
consistent with State systems development efforts. In the interest of 
equitable geographic distribution, special consideration for funding in 
this subcategory will be given to projects from communities without a 
currently-funded CISS project. Special consideration means that merit 
reviewers will assign scores based on the extent to which applicants 
address areas identified in this notice as meriting special 
consideration.
2. State Community Organization Grants
    Up to $1 million will be available to support up to 20 State 
Community Organization Grants to State MCH agencies in an amount up to 
$50,000 per year, beginning October 1, 1996. The project period is four 
years. Preference for funding of these grants will be given to State 
MCH agencies. The purpose of these grants is to strengthen ties between 
MCHB's community and State-level system development initiatives since 
FY 1992, thus reinforcing the benefits of the substantial investment in 
State and local infrastructure-building represented by ongoing SPRANS 
State Systems Development Initiative (SSDI) grants as well as CISS 
initiatives. Among State networking activities which may be supported 
by these grants are: providing technical assistance to community and 
local organizations needing help in systems development; convening 
statewide meetings; and disseminating and replicating successful local/
community strategies.
B. Health System Development in Child Care
    Up to $2.5 million is available to support up to 59 Health Systems 
Development projects in an amount up to $50,000 per year, beginning 
October 1, 1996. The project period is three years. The purpose of 
these grants is to support child care systems development and 
improvements through collaboration and integration of health care, 
child care, and social support services at State and communty levels. 
Each project will serve as a vehicle for State and community 
investments in systems development, service integration, and child care 
capacity development. Proposed systems improvements must identify and 
address appropriate Healthy People 2000 health status indicators and be 
consistent with the Blueprint for Action of the Healthy Child Care 
America Campaign. The Healthy Child Care America Campaign is a 
nationally-focused initiative, co-sponsored by the MCHB and the ACF's 
Child Care Bureau. The campaign supports the principle that, in 
partnership, families, health care providers, and child care providers 
can promote healthy development; and increase access to preventive 
health services and safe physical environments for all children, 
including children with special health needs. Because the program is 
aimed at building a unified, statewide systems approach to child care 
service integration, preference for funding will be given to the 59 
States and/or territories participating under Title V or to entities 
designated to assume the lead in a State or territory's child care 
development and service integration efforts. Proposals must show 
evidence of support by and collaboration between the State Title V and 
Child Care Directors.

Project Review and Funding

    Within the limit of funds determined by the Secretary to be 
available for the activities described in this announcement, the 
Secretary will review applications for funds as competing applications 
and may award Federal funding for projects which will, in her judgment, 
best promote the purpose of Title V of the Social Security Act, with 
special emphasis on improving service delivery to women and children 
from culturally distinct populations; best address achievement of 
Healthy Children 2000 objectives related to maternal, infant, child and 
adolescent health and service systems for children at risk of chronic 
and disabling conditions; and otherwise best promote improvements in 
maternal and child health.

Criteria for Review

    The criteria which follow are derived from MCH project grant 
regulations at 42 CFR Part 51a or from HRSA administrative policies 
that apply to all MCHB discretionary grant projects. These criteria are 
used, as pertinent, to review and evaluate applications for awards 
under all CISS grant categories announced in this notice. Further 
guidance in this regard is supplied in application guidance materials, 
which may specify other criteria:

Regulatory Criteria

--The quality of the project plan or methodology.
--The extent to which the project will contribute to the advancement of 
maternal and child health and/or improvement of the health of children 
with special health care needs;
--The extent to which the project is responsive to policy concerns 
applicable to MCH grants and to program objectives, requirements, 
priorities and/or review criteria for specific project categories, as 
published in program announcements or guidance materials.
--The extent to which the estimated cost to the Government of the 
project is reasonable, considering the anticipated results.
--The extent to which the project personnel are well qualified by 
training and experience for their roles in the project and the 
applicant organization has adequate facilities and personnel.
--The extent to which, insofar as practicable, the proposed activities, 
if well executed, are capable of attaining project objectives.

Administrative Policy Criteria

--The strength of the project's plans for evaluation.
--The extent to which the project will be integrated with the 
administration of the MCH Block Grant, State primary care plans, public 
health, and prevention programs, and other related programs in the 
respective State(s).
--The extent to which the application is responsive to the special 
concerns and program priorities specified elsewhere in this notice.

Eligible Applicants

    Any public or private entity, including an Indian tribe or tribal 
organization (as defined at 25 U.S.C. 450b), is eligible to apply for 
CISS grants.

Executive Order 12372

    The MCH Federal set-aside program has been determined to be a 
program which is not subject to the provisions of Executive Order 12372 
concerning intergovernmental review of Federal programs.

    The OMB Catalog of Federal Domestic Assistance number is 93.110.

    Dated: June 17, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-15788 Filed 6-19-96; 8:45 am]
BILLING CODE 4160-19-P