[Federal Register Volume 62, Number 17 (Monday, January 27, 1997)]
[Notices]
[Pages 3903-3906]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-1928]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Healthy Start Cooperative Agreements

AGENCY: Health Resources and Services Administration (HRSA).

ACTION: Notice of availability of funds.

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

SUMMARY: The HRSA announces that approximately $54 million dollars in 
fiscal year (FY) 1997 funds will be available for cooperative 
agreements to communities for the replication phase of the Healthy 
Start Initiative, hereafter called Healthy Start-Phase II. The Healthy 
Start Initiative is a program of projects which, since FY 1991, has 
developed and implemented community-based strategies to reduce infant 
mortality in areas with a high incidence of infant mortality. The 
purpose of Healthy Start-Phase II is to operationalize successful 
infant mortality reduction strategies developed during the 
demonstration phase and to launch Healthy Start projects in new rural 
and urban communities (i.e., communities currently without a Healthy 
Start-funded project). Competition is open to community-based entities 
interested in replicating or adapting existing Healthy Start models 
with assistance from selected Healthy Start projects already in 
operation. The project period is four years, subject to continuing 
availability of funds.
    Within the HRSA, the Healthy Start Initiative is administered by 
the Maternal and Child Health Bureau (MCHB). Cooperative agreements for 
Healthy Start-Phase II will be made under the program authority of 
Section 301 of the Public Health Service Act. Funds for these awards 
were appropriated under Public Law 104-208.
    The 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 Healthy Start-Phase II program 
will directly address the Healthy People 2000 objectives related to 
maternal and infant health, and especially health status objective 
14.1, to reduce the infant mortality rate to no more than 7 per 1000 
live births. 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, U.S. Government Printing 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.

ADDRESSES: The Federal Register notices and application guidance for 
the Healthy Start program 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.
    For applicants for Healthy Start cooperative agreements who are 
unable to access application materials electronically, a hard copy 
(Revised PHS form 5161-1, approved under OMB clearance number 0937-
0189) must be obtained from the HRSA Grants Application Center. 
Requests should specify the category or categories of activities for 
which an application is requested so that the appropriate forms, 
information and materials may be provided. The Center may be contacted 
by: Telephone Number: 1-888-300-HRSA, FAX Number: 301-309-0579, E-mail 
Address: [email protected]. Completed applications should be 
returned to: Grants Management Officer (CFDA #93.926), HRSA Grants 
Application Center, 40 West Gude Drive, Suite 100, Rockville, Maryland 
20850.

DATES: The application deadline date is April 15, 1997. Applications 
will be considered to be on time 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 competing applications or those sent to an address other 
than that specified in the ADDRESSES section will be returned to the 
applicant.

FOR FURTHER INFORMATION: Requests for technical or programmatic 
information should be directed to Thurma McCann, M.D., M.P.H., 
Director, Division of Healthy Start, Maternal and Child Health Bureau, 
HRSA, 5600 Fishers Lane, Room 11-A-05, Rockville, Maryland 20857, 
telephone 301-443-0543. Requests for information concerning 
administration and business management issues should be directed to 
Sandy Perry, Chief, Grants Management Branch, Maternal and Child Health 
Bureau, 5600 Fishers Lane, Room 18-12, Rockville, Maryland, 20857, 
telephone 301-443-1440.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

    The Healthy Start Initiative was established as a demonstration 
program in 1991, based on the premise that new community-based 
strategies were needed to attack the causes of infant mortality and low 
birthweight especially among high risk populations.
    Currently, there are 22 Healthy Start demonstration projects that 
have developed strategies to reduce infant mortality in their 
respective communities. Several of these strategies have been highly 
effective in achieving project objectives.
    Approved applicants for this competition must agree to receive peer 
mentoring from existing Healthy Start grantees regarding the 
replication or adaptation of one or more of the strategies identified 
below. These strategies are categorized into nine intervention models 
(one organizational and eight service):
    1. Community-Based Consortium--Establishment of a local community-
based consortium/advisory board/coalition (consortium) of consumers 
(i.e., recipients of project services within the catchment area), 
providers, and others in an advisory capacity for program planning, 
operations, monitoring, and evaluation.
    2. Family Resource Center--Provision of a community driven 
comprehensive array of client services at a single site at an 
accessible community location.

[[Page 3904]]

    3. Enhanced Clinical Services--Enhancement of quality, access, 
utilization, and/or client satisfaction of clinical services that are 
provided by providers such as health department clinics, hospitals, and 
community clinics.
    4. Risk Prevention and Reduction--Provision of specialized services 
which address population based and/or system oriented issues to reduce, 
modify, and/or eliminate medical/psycho-social stressors or unhealthy 
behaviors that threaten or affect childbearing women and their 
families.
    5. Care Coordination/Case Management--Provision of services in a 
coordinated approach through client assessment, monitoring, 
facilitation and follow-up of utilization of needed services.
    6. Outreach/Client Recruitment--Provision of case finding services 
which actively reach out into the community to recruit perinatal 
clients.
    7. Facilitating Services--Provision of enabling services such as 
translation, transportation, and child care to assist clients to 
receive services and participate in infant mortality reduction 
programs.
    8. Education and Training--Provision of planned education and 
public information to address risk factors associated with infant 
mortality, and to improve individual and community health.
    9. Adolescent Programs--Provision of services which focus on the 
unique needs of adolescents to help them understand the need for 
pregnancy prevention and the complexities of childbearing.

Eligible Applicants

    Applicants for Healthy Start-Phase II cooperative agreements must 
be public or nonprofit private organizations, or tribal and other 
organizations representing American Indians, Alaskan Natives, Native 
Hawaiians,or Pacific Islanders, applying as or on behalf of an existing 
community-based consortium, and have infant mortality reduction 
initiatives already underway. In the case of overlapping project areas 
or more than one applicant for the same project area, only one 
application will be considered for funding. Applicants must be in 
partnership with a current consortium which has been: (1) In operation 
at least the last 2 years prior to date of the application; and (2) 
involved in MCH activities (e.g. health fairs, support groups) in the 
project area. A consortium which has organized as a community-based 
organization may apply if it has demonstrable management and 
administrative experience.

Eligible Project Areas

    New communities targeted under Healthy Start-Phase II are those in 
which infant mortality problems are most severe, resources can be 
concentrated, implementation is manageable, and progress can be 
measured.
    A project area is defined as a geographic area for which 
improvements have been planned and are being implemented. A project 
area must represent a reasonable and logical catchment area. The 
project consortium's responsibility for this catchment area includes 
the provision of ongoing advice to and oversight of the delivery of 
project services for the duration of the project period. Proposed 
activities should incorporate the Healthy Start principles of 
innovation, community commitment and involvement, increased access, 
service integration, and personal responsibility.
    Applicants are eligible for funding under Healthy Start-Phase II 
if, for the baseline three-year period of 1991-1993 (unless other wise 
specified), the proposed project area had the following verifiable 
characteristics:

--An average infant mortality rate of at least 12.9 deaths per 1,000 
live births, from vital statistics data, and at least three of the 
following:

     A percentage of births to teens which exceeded the 
national average of 5.0 percent of live births;
     A percentage of low birth weight births which exceeded the 
national average of 7.1 percent of live births;
     A rate of postneonatal mortality which exceeded the 
national average of 3.6 per 1,000 live births;
     A percentage of children under 18 with family incomes 
below the Federal Poverty Level which exceeded the national average of 
22 percent for 1993 only.

Funding Category

    The single category open for competition this year will be 
cooperative agreements with new communities seeking funds to replicate 
or adapt successful Healthy Start strategies to reduce infant 
mortality, in conjunction with individual programs already underway. 
Approximately $54,000,000 is available to fund up to 30 new 
communities, with awards ranging from $250,000 up to $2,000,000 per 
project for one year. The project period is up to four years, subject 
to continuing availability of funds.
    Consideration for funding will be given to projects which 
operationalize and replicate one or more of the identified service 
intervention models, whose implementation appears reasonable and 
appropriate, which can be accomplished within the project period, and 
which are linked to a perinatal system of care.
    In addition, Healthy Start-Phase II funds may be used only to 
supplement, and not to supplant or replace, either existing State or 
local funds, or State or local funds that would otherwise be made 
available to the project. Any appearance of supplantation will 
disqualify the application.
    It is anticipated that intensive Federal programmatic involvement 
and substantial consultation will be required with grantees and 
mentoring organizations in these cooperative agreements. Federal 
involvement may include planning, guidance, coordination and 
participation in programmatic activities. Periodic meetings, 
conferences, and/or communications with the award recipients are held 
to review mutually agreed upon goals and objectives and to assess 
progress. The outcome of Federal oversight activities could lead to 
adjustments in priority tasks for a project.
    A separate, limited competition among existing Healthy Start 
projects will complement these new Healthy Start-Phase II grants. It 
will provide funding for: (1) continued support of successful 
strategies and interventions; and (2) peer mentoring of health care 
providers, including managed care organizations and the new Healthy 
Start communities. This limited competition will be conducted 
separately and apart from the open competition announced in this 
notice.

Special Concerns

    HRSA's Maternal and Child Health Bureau places special emphasis on 
improving service delivery to women, infants, children and youth from 
communities with limited access to comprehensive care. In order to 
assure access and cultural competence, it is expected that projects 
will involve individuals from the populations to be served in the 
planning and implementation of the project. The Bureau'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

[[Page 3905]]

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, HRSA will place a funding priority on projects from 
Historically Black Colleges and Universities (HBCU) or Hispanic Serving 
Institutions in all categories and subcategories in this notice for 
which applications from academic institutions are encouraged. This is 
in conformity with the Federal Government's policies in support of 
White House Initiatives on Historically Black Colleges and Universities 
(Executive Order 12876) and Educational Excellence for Hispanic 
Americans (Executive Order 12900). An approved proposal from a HBCU or 
Hispanic Serving Institution will receive a 0.5 point favorable 
adjustment of the priority score in a 4 point range before funding 
decisions are made.

Evaluation Protocol

    All Healthy Start projects, must 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 
grant 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.

Review Process

    Because of the anticipated overwhelming response to this 
announcement and the inability to fund all that may be approved, 
applications for the Healthy Start-Phase II will be reviewed in two 
stages. Stage 1 will consist of a competitive review by an Objective 
Review Committee (ORC) of all of the applications that have been 
determined eligible. Once the ORC has completed this initial review, 
those applicants determined to be highly competitive will receive a 
Stage 2 pre-award validation site visit to reaffirm the information 
contained in the applications and the applicant's ability to replicate 
the chosen model(s). There will be separate ORC panels for urban and 
rural applicants.
    Five pre-application conferences for interested and potential 
applicants will be held February, 1997. These conferences will present 
the Healthy Start Initiative and its models of intervention, as well as 
answer questions relevant to the solicitation and review of 
applications. These conferences are planned for the metropolitan areas 
of Washington, D.C., (February 10), Atlanta, GA (February 12), Los 
Angeles, CA (February 20), Kansas City, MO (February 24), and 
Rockville, MD (February 28).
    Interested parties should complete the registration form located 
within the application kit and return it via fax by February 1, 1997 to 
the National Center for Education in Maternal and Child Health 
(NCEMCH). An eletronic version of the registration form is also 
available through the Healthy Start eletronic mail addresss listed 
below. The completed registration form should be faxed to NCEMCH at 
(703) 524-9335.
    For more information, please refer to the guidance or contact 
NCEMCH's Healthy Start Project via electronic mail, 
[email protected] or telephone 703-524-6537.

Review Criteria for Applicants

    The following factors will be used, to review and evaluate 
applications for awards announced in this notice:

Stage 1

     Factor I (Weight-5 percent): The soundness of the 
application, as measured by the logical flow of the narrative, the 
quality of its content and its proposed methodology.
     Factor II (Weight-35 percent): The extent to which the 
proposed project is adequately described, as measured by the following:

--The extent to which the demonstrated need(s) of the target population 
to be served is adequately described and supported in the needs 
assessment and summarized in the problem statement.
--The extent to which the proposed project plan addresses the 
appropriate documented need(s) of the targeted population, including 
attention to the cultural and linguistic needs of consumers.
--The extent to which the proposed project plan is congruent with the 
scope of one or more of the eight service models of intervention.
--The extent to which the proposed project plan is adequately 
described. This description should delineate the specific model 
strategies included in the proposed project plan, and identify the 
actual or anticipated agencies and resources that will be used to 
implement those strategies.
--The extent to which the proposed project plan will enhance existing 
infant mortality reduction activities already underway within the 
community.
--The extent to which the project plan's objectives incorporate 
performance based indicators that are measurable, logical, and 
appropriate in relation to the specific problems and Healthy Start 
model(s) identified.
--The extent to which the activities involved in each proposed model 
appear feasible and likely to contribute to the achievement of the 
project's objectives within each budget period.

     Factor III (Weight-20 percent): The applicant's fiscal and 
program management capability and/or capacity, as measured by:

--The extent of the applicant's capability to carry out the replication 
or adaptation of the proposed model(s) within the project area and to 
play a substantive role in carrying out project activities associated 
with the model(s).
--The extent to which the applicant has demonstrated an ability to 
maximize and coordinate existing resources and acquire additional 
resources.
--The extent to which the plan to measure program performance is well 
organized, adequately described, and complies with MCHB's evaluation 
protocol for its discretionary grants and cooperative agreements.

     Factor IV (Weight-10 percent): Evidence of support from 
and linkage to the State and local perinatal systems, as measured by:

--The extent to which the project is linked to an existing perinatal 
system of care and enhances the applicant's infant mortality reduction 
program already in operation.
--The extent of actual or planned involvement of the State and local 
MCH and/or the Indian Health Service Area MCH Coordinator (as 
appropriate) and other agencies is clearly evident.
--The extent to which the project is consonant with overall State 
efforts to develop comprehensive community based systems of services, 
and focuses on service needs identified in the State's MCH Services 
Block Grant Plan.

     Factor V (Weight-15 percent): Structure and Role of 
Applicant's Consortium, as measured by:


[[Page 3906]]


--The effectiveness of the consortium activities during its years of 
existence, as demonstrated by evidence that the consortium has an 
ongoing advisory role in the project community's MCH activities.
--The extent to which the consortium includes appropriate 
representation of project area consumers, providers, and other key 
stake holders.
--The role and plan of action of the consortium in the implementation 
of the proposed project plan is adequately described.

     Factor VI (Weight-15 percent): The appropriateness of the 
budget, as measured by:

--The extent to which the proposed budget is realistic, adequately 
justified, and consistent with the proposed project plan.
--The extent to which the costs of administration and evaluation are 
reasonable and proportionate to the costs of service provision.
--The degree to which the costs of each model are economical in 
relation to the proposed service utilization.

Stage 2

     Validation Site Visit (Weight-100 percent):

--Reaffirmation of the applicant's information, consortium's structure 
and activities, and existing service systems and operations, based on a 
pre-award site visit to those applicants for whom the objective review 
committee has scored as highly competitive. The site visit will include 
assessments of the following:

I. Grantee Capability
II. Consortium Role and Structure
III. State and Local Perinatal System Linkage
IV. Other Factors As Appropriate

Preference

    Preference for funding will be given to projects which: (1) Help to 
achieve an equitable geographical distribution of projects across all 
States and territories; or (2) show strong evidence of sustainability 
beyond the period of federal Healthy Start funding, such as those in 
Enterprise Zones/Empowerment Communities or with other substantial 
commitments of public or private sector resources.

Allowable Costs

    The Health Resources and Services Administration will support 
reasonable and necessary costs of Healthy Start-Phase II grants within 
the scope of approved activities. Allowable costs may include salaries, 
equipment and supplies, travel, contractual, consultants, and others, 
as well as indirect costs. HRSA adheres to administrative standards 
reflected in the Code of Federal Regulations 45 CFR Part 92 and 45 CFR 
Part 74. All other sources of funding to support this project must be 
accurately reflected in the applicant's budget.

Reports

    A successful applicant under this notice will submit reports in 
accordance with the provisions of the general regulations which apply 
under 45 CFR Part 74, Subpart J, Monitoring and Reporting of Program 
Performance, with the exception of State and local governments, to 
which 45 CFR Part 92, Subpart C reporting requirements will apply. 
Financial reporting will be required in accordance with 45 CFR Part 74, 
Subpart H, with the exception of State and local governments, to which 
45 CFR 92.20 will apply.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements (approved under OMB No. 0937-0195). Under these 
requirements, community-based nongovernmental applicants 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:

    (a) A copy of the face page of the application (SF 424).
    (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.
    (3) A description of the coordination planned with the 
appropriate State or local health agencies.

Executive Order 12372

    This 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 such a review 
system and will provide a single point of contact (SPOC) in the States 
for review. Applicants (other than federally-recognized Indian tribal 
governments) should contact their State 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 application deadline for new and competing awards. The 
granting agency does not guarantee to ``accommodate or explain'' for 
State process recommendations it receives after that date.

    The OMB Catalog of Federal Domestic Assistance number is 93.926.

    Dated: January 22, 1997.
Ciro V. Sumaya,
Administrator.
[FR Doc. 97-1928 Filed 1-24-97; 8:45 am]
BILLING CODE 4160-15-P