[Federal Register Volume 61, Number 141 (Monday, July 22, 1996)]
[Notices]
[Pages 37917-37921]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-18442]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Availability of Funds for Grants to Provide Health Care for the 
Homeless and Health Care Services for Homeless Children

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of available funds.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that the President's budget for fiscal year (FY) 1997 
includes approximately $65.4 million for discretionary grants to 
provide primary health and substance abuse services to homeless 
individuals. These grants will be awarded under Section 340 of the 
Public Health Service (PHS) Act, 42 U.S.C. 256. This announcement is 
made prior to an appropriation of FY 1997 funds, to allow applicants 
sufficient time to prepare applications and to enable timely award of 
the grants in consideration of the special needs of homeless 
individuals. Approximately $6.3 million will be used to fund 
continuation of services where there is an expiring project period.
    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

[[Page 37918]]

Office, Washington, D.C. 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.

DUE DATE: Applications are due 120 days prior to project end date, with 
the first due date being August 1, 1996 and the last date being March 
1, 1997. However, to allow potential applicants sufficient time to 
prepare application materials for those areas in which grants are 
expiring on October 31, 1996, applications for grants beginning 
November 1, 1996 will be due 90 days prior to the expiration of the 
current grant award or no later than August 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 the appropriate PHS Regional Grants 
Management Officer (RGMO) (see Appendix A). The RGMO can also provide 
assistance on business management issues.

FOR FURTHER INFORMATION CONTACT: For general program information and 
technical assistance, contact Ms. Jean Hochron, Chief, Health Care for 
the Homeless Branch, Division of Programs for Special Populations, 
Bureau of Primary Health Care (BPHC), at 4350 East-West Highway, 
Bethesda, Maryland 20814 (telephone 301-594-4430).

ELIGIBLE APPLICANTS: It is the intent of HRSA to continue to support 
health services to the homeless populations currently being served 
given the needs of this medically underserved population. Any nonprofit 
private organization or public entity may apply to serve the homeless 
population currently served by a grantee whose project period is 
expiring. For a list of service areas with expiring project periods, 
see Federal Register notice published on June 17, 1996, at 61 FR 30622.
SUPPLEMENTARY INFORMATION: It is anticipated that approximately 16 
Health Care for the Homeless and 1 Health Care Services for Homeless 
Children competing grants will be awarded to serve homeless individuals 
in urban and rural areas. Grants will range from approximately $88,000 
to approximately $1.2 million for primary health care and substance 
abuse services.
    A project period is the total amount of time for which a grant has 
been programmatically approved. For purposes of this notice, grant 
awards will be made for a one year budget period and up to a five year 
project period.

Grants Awarded Under Section 340(a)

    Section 340(a) of the PHS Act authorizes the Secretary to award 
grants to enable grantees, directly or through contracts, to provide 
for the delivery of primary health services to homeless individuals. 
Eligible applicants are nonprofit private organizations and public 
entities, including State and local governmental agencies. Grantees and 
organizations with whom they may contract for services under this 
program must have an agreement with a State under its Medicaid program, 
title XIX of the Social Security Act (if they provide services that are 
covered under the title XIX plan for the State), and be qualified to 
receive payments under the agreement. This requirement may be waived if 
the organization does not, in providing health care services, impose a 
charge or accept reimbursement available from any third-party payor 
including reimbursement under any insurance policy or under any Federal 
or State health benefits program.
    For grantees not previously funded under section 340(a), the amount 
of Federal grant funds awarded may not exceed 75 percent of the costs 
of providing primary health and substance abuse services under the 
grant. Such newly funded grantees must make available non-Federal 
contributions to meet the remainder of the costs. Existing 340(a) 
grantees, if funded, must make available 33\1/3\ percent non-Federal 
contributions to meet the remainder of the costs. Non-Federal 
contributions may be in cash or in-kind, fairly evaluated, including 
plant, equipment or services. Funds provided by the Federal Government, 
or services assisted or subsidized to any significant extent by the 
Federal Government, may not be included in determining the amount of 
the non-Federal contributions. Such determination may not include any 
cash or in-kind contributions that, prior to February 26, 1987, were 
made available by any public or private entity for the purpose of 
assisting homeless individuals (including assistance other than the 
provision of health services). The Secretary may waive the matching 
requirement if the grantee is a nonprofit private entity and the 
Secretary determines that it is not feasible for the grantee to comply 
with the requirement.
    The grant may be used to continue to provide services listed below 
for up to 12 months to individuals who have obtained permanent housing 
if services were provided to these individuals when they were homeless. 
For the purpose of this program, the term ``homeless individual'' means 
an individual who lacks housing (without regard to whether the 
individual is a member of a family), including an individual whose 
primary residence during the night is a supervised public or private 
facility that provides temporary living accommodations, or an 
individual who is a resident in transitional housing.

Project Requirements

    a. The following services must be provided, directly or through 
contract:
    1. Primary health care and substance abuse services at locations 
accessible to homeless individuals;
    2. 24-hour emergency primary health and substance abuse services to 
homeless individuals;
    3. Referral of homeless individuals as appropriate to medical 
facilities for necessary hospital services;
    4. Referral of homeless individuals who are mentally ill to 
entities that provide mental health services, unless the applicant will 
provide such services directly;
    5. Outreach services to inform homeless individuals of the 
availability of primary health and substance abuse services;
    6. Aid to homeless individuals in establishing eligibility for 
assistance, and in obtaining services, under entitlement programs.
    7. Podiatry, dental (including dentures), and vision services are 
supplemental services and may be provided where medically necessary, to 
the extent that the level of delivery of the required services is not 
diminished.

Grants Awarded Under Section 340(s)

    Section 340(s) of the PHS Act authorizes the Secretary to carry out 
demonstration programs to enable

[[Page 37919]]

entities, either directly or through contracts, to provide for the 
delivery of comprehensive primary health services to homeless children 
and to children at imminent risk of homelessness. Eligible applicants 
are grantees funded under 340(a) of the PHS Act, other public and 
nonprofit private entities that provide primary health services and 
substance abuse services to a substantial number of homeless 
individuals, and public nonprofit private children's hospitals that 
provide primary health services to a substantial number of homeless 
individuals. Grantees and organizations with which they may contract 
for services under this program must have an agreement with a State 
under its Medicaid program, title XIX of the Social Security Act (if 
they provide services that are covered under the title XIX plan for the 
State), and be qualified to receive payments under the agreement. This 
requirement may be waived if the organization does not, in providing 
health care services, impose a charge or accept reimbursement available 
from any third-party payor, including reimbursement under any insurance 
policy or under any Federal or State health benefits program.
    For grantees under this program which are children's hospitals, the 
amount of Federal grant funds awarded may not exceed 50 percent of the 
costs of providing primary health and substance abuse services under 
the grant. Grantees which are children's hospitals must make available 
non-Federal contributions to meet the remainder of the costs. Non-
Federal contributions may be in cash or in-kind, fairly evaluated, 
including plant, equipment or services. Funds provided by the Federal 
Government or services assisted or subsidized to any significant extent 
by the Federal Government, may not be included in determining the 
amount of the non-Federal contributions.

Project Requirements

    a. The following services must be provided directly or through 
contract:
    1. Comprehensive primary health services, including such services 
provided through mobile medical units;
    2. Referrals for provision of health services, social services, and 
education services, including referral to hospitals, community and 
migrant health centers, Head Start and other education programs, and 
programs for prevention and treatment of child abuse; and
    3. Outreach services to identify children who are homeless or at 
imminent risk of homelessness and to inform parents/guardians of the 
availability of services directly from the grantees and through the 
referral mechanism.

Other Grant Requirements Applicable to Both Sections 340(a) and 
340(s) Grantees

    a. Restrictions on the use of grant funds are as follows:
    1. Grant funds may not be used to pay for inpatient services, 
except for residential treatment for substance abuse provided in 
settings other than hospitals.
    2. Grant funds may not be used to make cash payments to intended 
recipients of primary health and substance abuse services or mental 
health services.
    3. Grants funds may not be used to purchase or improve real 
property (other than minor remodeling of existing improvements to real 
property) or to purchase major medical equipment, including mobile 
medical units. However, upon request by an applicant demonstrating that 
the purposes of the project cannot otherwise be carried out, the 
Secretary may waive this restriction.
    b. The grantee must, directly or through contract, provide services 
without regard to ability to pay for the services. If a charge is 
imposed for the delivery of services, such charge (1) will be made 
according to a schedule of charges that is made available to the 
public; (2) will not be imposed on any homeless individual with an 
income less than the official poverty level (the nonfarm income 
official poverty line defined by the Office of Management and Budget); 
(3) will be adjusted to reflect the income and resources of the 
homeless individual involved.

Additional Grant Requirements for Section 340(a) Only

    a. The grantee may not expend more than 10 percent of grant funds 
for the purpose of administering the grant.
    b. The grantee may, with respect to title I of the Protection and 
Advocacy for Mentally Ill Individuals Act of 1986, expend amounts 
received for the purpose of referring homeless individuals who are 
chronically mentally ill, and who are eligible under the Act, to 
systems that provide advocacy services under the Act.
    c. The grantee may provide services through contracts with 
nonprofit selfhelp organizations that are established and managed by 
current and former recipients of mental health or substance abuse 
services, who have been homeless individuals; and that have an 
agreement with a State under its Medicaid program, title XIX of the 
Social Security Act (if they provide services that are covered under 
the title XIX plan for the State), and qualify to receive payments 
under the agreement.

Criteria for Evaluating Applications for Section 340(a) and 340(s)

Competing Applications 340(a)

    These competitive applications for grant support will be reviewed 
based upon the following evaluation criteria:
    a. Compliance with the requirements of section 340(a) of the PHS 
Act and other programmatic requirements;
    b. Experience in providing primary health or substance abuse 
services to homeless individuals or medically underserved populations.
    c. Extent to which the applicant has identified the homeless 
population in the service area, including the social and demographic 
characteristics of the population and the extent to which their health 
needs are not being met;
    d. Adequacy of the applicant's outreach plan to serve the homeless 
population;
    e. Extent to which primary health and substance abuse services are 
to be provided to homeless individuals in a manner that demonstrates 
program linkages and services integration;
    f. Adequacy of the applicant's referral arrangement to appropriate 
medical facilities for hospitalization and, for individuals who are 
mentally ill, to entities that provide mental health services, unless 
the applicant will provide such services directly;
    g. Extent to which the applicant has the ability to involve 
appropriate community representatives to ensure that the program is 
culturally appropriate and accommodates the needs of homeless 
individuals in the service area;
    h. Extent to which the applicant has engaged or plans to engage 
with other entities in an integrated service system in the community;
    i. Qualifications and experience of the proposed project staff; 
i.e., the staff size and skills necessary to carry out an effective 
program;
    j. Adequacy of the proposed budget; i.e., detailed estimates of 
revenue and costs in accordance with grant application instructions;
    k. Evidence of administrative procedures for fiscal control and 
fund accounting procedures which provide for reasonable financial 
administration of Federal and non-Federal funds;
    l. Evidence of an ongoing program of quality assurance with respect 
to health services provided under the grant;
    m. Evidence of a reasonable plan for communicating with non-English 
speaking homeless individuals provided health services under the grant;

[[Page 37920]]

    n. Indication of strategies for collaborative relationships and 
linkages which maximize effective use of existing health and social 
service resources, especially those of state and local health 
department, primary care providers to the underserved, and academic 
institutions; and
    o. A current grantee's progress in achieving stated goals and 
objectives for the previous year's grant.

Competing Applications 340(s)

    These competitive applications for grant support will be reviewed 
based upon the following evaluation criteria:
    a. Compliance with the requirements of section 340(s) of the PHS 
Act and other programmatic requirements;
    b. Experience in providing primary health or substance abuse 
services to homeless individuals or medically underserved populations;
    c. Extent to which the applicant has identified homeless children 
and children at imminent risk of homelessness within the service area, 
including the social and demographic characteristics of these children 
and the extent to which their health needs are not being met;
    d. Proposal of an innovative approach to meeting the health care 
needs of homeless children and children at imminent risk of 
homelessness, which can be utilized as a demonstration site for other 
programs nationally;
    e. Adequacy of the applicant's outreach plan to identify homeless 
children and children at imminent risk of homelessness and inform their 
parents/guardians of the availability of services;
    f. Extent to which primary health services are to be provided to 
homeless children in a linked and integrated manner;
    g. Adequacy of the applicant's referral arrangements for the 
provision of health services, social services, and education services, 
including referral to hospitals, community and migrant health centers, 
Head Start and other educational programs, and programs for prevention 
and treatment of child abuse;
    h. Extent to which the applicant has the ability to involve 
appropriate community representatives to ensure that the program 
accommodates the needs of homeless children and children at imminent 
risk of homelessness in the service area;
    i. Extent to which the applicant has engaged or plans to engage 
with other entities in an integrated service system in the community;
    j. Qualifications and experience of the proposed project staff; 
i.e., the staff size and skills necessary to carry out an effective 
program;
    k. Adequacy of the proposed budget; i.e., detailed projections of 
revenue and costs in accordance with grant application instructions;
    l. Evidence of administrative procedures for fiscal control and 
fund accounting procedures which provide for reasonable financial 
administration of Federal and non-Federal funds;
    m. Evidence of an ongoing program of quality assurance with respect 
to health services provided under the grant;
    n. Evidence of a reasonable plan for communicating with non-English 
speaking children provided health services under the grant and their 
parents/guardians; and
    o. Indication of strategies for collaborative relationships and 
linkages which maximize effective use of existing health and social 
service resources, especially those of state and local health 
department, primary care providers to the underserved, and academic 
institutions.
    p. A current grantee's progress in achieving stated goals and 
objectives for the previous year's grant.

Other Award Information

    The Health Care for the Homeless program 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.)

Public Health System Reporting Requirement

    Section 340 general primary care services delivery grants are 
subject to the Public Health System Reporting Requirement, PHS 92.01. 
Reporting requirements have been approved by the OMB under control 
numbers 0937-0195. Under this requirement, 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. 
Applicants may submit the Project Summary section of the application as 
the PHSIS. Community-based nongovernmental applicants are required to 
submit a copy of the face page of the application (SF 424) 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. In the 
OMB Catalog of Federal Domestic Assistance, the Health Care for the 
Homeless program is listed as Number 93.151.

    Dated: July 16, 1996.
Ciro V. Sumaya,
Administrator.

Appendix A

Region I

(CT, ME, MA, NH, RI, VT)

Grants Management Officer, PHS Office of Grants Management, John F. 
Kennedy Federal Bldg. #1400, Boston, Massachusetts 02203, (617) 565-
1426

Region II

(NJ, NY, PR, VI)

Grants Management Officer, PHS Office of Grants Management, 26 
Federal Plaza #3337, New York, New York 10278, (212) 264-2549

Region III

(DE, DC, MD, PA, VA, WV)

Grants Management Officer, PHS Office of Grants Management, 3535 
Market Street #10-140, Philadelphia, Pennsylvania 19101, (215) 596-
6655

Region IV

(AL, FL, GA, KY, MS, NC, SC, TN)

Grants Management Officer, PHS Office of Grants Management, 101 
Marietta Tower, Suite 1121, Atlanta, Georgia 30323, (404) 331-2597

Region V

(IL, IN, MI, MN, OH, WI)

Grants Management Officer, PHS Office of Grants Management, 105 West 
Adams,

[[Page 37921]]

17th Floor, Chicago, Illinois 60603, (312) 353-8700

Region VI

(AR, LA, NM, OK, TX)

Grants Management Officer, PHS Office of Grants Management, 1200 
Main Tower Bldg. #1800, Dallas, Texas 75202, (214) 767-3885

Region VII

(IA, KS, MO, NE)

Grants Management Officer, PHS Office of Grants Management, 601 East 
12th Street #501, Kansas City, Missouri 64106, (816) 426-5841

Region VIII

(CO, MT, ND, SD, UT, WY)

Grants Management Officer, PHS Office of Grants Management, 1961 
Stout St., Fed. Bldg. #492, Denver, Colorado 80294, (303) 844-4461

Region XI

(AS, AZ, CA, GU, HI, NV, TT)

Grants Management Officer, PHS Office of Grants Management, 50 
United Nations Plaza #331, San Francisco, California 94102, (415) 
437-8125

Region X

(AK, ID, OR, WA)

Grants Management Officer, PHS Office of Grants Management, 2201 6th 
Avenue, #710, Seattle, Washington 98121, (206) 615-2474

[FR Doc. 96-18442 Filed 7-19-96; 8:45 am]
BILLING CODE 4160-15-P