[Federal Register Volume 62, Number 59 (Thursday, March 27, 1997)]
[Notices]
[Pages 14684-14687]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-7727]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration


Special Project Grants; Traumatic Brain Injury Demonstration 
Grants

AGENCY: Health Resources and Services Administration (HRSA).

ACTION: Notice of availability of funds.

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

SUMMARY: The HRSA announces that approximately $2.8 million in fiscal 
year (FY) 1997 funds will be available for demonstration projects to 
improve access to health and other services for people who have 
sustained a traumatic brain injury (TBI). Discretionary grants

[[Page 14685]]

to States are authorized under section 1252 of the Public Health 
Service (PHS) Act, as amended by Public Law 104-166 (42 USC 300d-52), 
which provides for the conduct of expanded studies and the 
establishment of innovative programs with respect to TBI. Funds for TBI 
State demonstration projects are appropriated by Public Law 104-208. At 
present, funding for this program is available for one year. Within the 
HRSA, TBI grants are administered by the Maternal and Child Health 
Bureau (MCHB).
    The PHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2000, a PHS lead national 
activity for setting priority areas. The TBI grant program will 
directly address the Healthy People 2000 objectives related to chronic 
disabling conditions, particularly in relation to service system 
expansion and objectives related to secondary injury prevention. 
Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report: Stock No. 017-001-00474-0) or Healthy People 2000 Midcourse 
Review and 1995 Revisions (Stock No. 017-001-00526-6) through the 
Superintendent of Documents, Government Printing Office, Washington, 
D.C. 20402-9325 (telephone: 202-512-1800).
    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: 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.
    For applicants for TBI Demonstration Grants who are unable to 
access application materials electronically, a hard copy (Revised PHS 
form 5161-1, approved under OMB clearance number 0937-0189) may be 
obtained from the HRSA Grants Application Center. 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.TBA-1), HRSA 
Grants Application Center, 40 West Gude Drive, Suite 100, Rockville, 
Maryland 20850.

DATES: The application deadline date is May 30, 1997. Competing 
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.

FOR FURTHER INFORMATION CONTACT: Requests for technical or programmatic 
information from MCHB should be directed to the Division of Maternal, 
Infant, Child and Adolescent Health (DMICAH), Maternal and Child Health 
Bureau, Health Resources and Services Administration, Room 18A-39, 
Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857. The 
DMICAH telephone number for TBI inquiries is 301-443-5559. Requests for 
information concerning fiscal, business or administrative management 
issues should be directed to: Maria E. Carter, Grants Management 
Specialist, Grants Management Branch, Maternal and Child Health Bureau, 
5600 Fishers Lane, Room 18-12, Rockville, Maryland 20857, telephone: 
301-443-3268.

SUPPLEMENTARY INFORMATION:

Program Background and Objectives

    In July, 1996, Congress enacted Public Law 104-166, ``to provide 
for the conduct of expanded studies and the establishment of innovative 
programs with respect to traumatic brain injury'' (TBI). Under Public 
Law 104-166, a program of grants to States for demonstration projects 
to improve access to health and other TBI-related services for people 
of all ages is established within HRSA. The National Institutes of 
Health has responsibility for conducting basic and applied research 
regarding TBI. Responsibility for activities related to prevention of 
TBI is assigned to the Centers for Disease Control and Prevention. 
Information on CDC grant activities which relate to TBI surveillance 
may be obtained from David J. Thurman, M.D., M.P.H., Division of Acute 
Care, Rehabilitation Research, and Disability Prevention, National 
Center for Injury Prevention and Control, CDC, 4770 Buford Highway, NE, 
Mailstop F-41, Atlanta, GA 30341, telephone: 770-488-4031. Public Law 
104-166 also mandates a national consensus conference of appropriate 
PHS agencies to study a range of TBI-related issues, including 
development of a uniform reporting system, evaluation of the 
effectiveness of common therapeutic interventions, assessment of the 
adequacy of existing outcome measures, and development of practice 
guidelines for rehabilitation.
    The law requires any State seeking TBI demonstration grant funds to 
agree to establish an advisory board within the appropriate health 
department of the State or within another department as designated by 
the chief executive officer of the State. The Board's composition is 
specified; it must include: representatives of the involved State 
agencies; public and nonprofit private health related organizations; 
disability advisory or planning groups; members of an organization or 
foundation representing TBI survivors; State and local injury control 
programs if they exist, and a substantial number of TBI survivors or 
their family members. The State must also make available matching 
funds, in cash non-Federal contributions, in an amount that is not less 
than $1 for each $2 of Federal funds provided under the grant.

Definitions

    1. State: For purposes of this grant program, the term ``State'' 
includes the 50 States, the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, the Northern Mariana Islands, Guam, 
American Samoa, the Republic of Palau, the Republic of the Marshall 
Islands, and the Federated States of Micronesia.
    2. Traumatic Brain Injury: For purposes of this grant program 
``Traumatic Brain Injury'' (TBI) means an acquired injury to the brain. 
Such term does not include brain dysfunction caused by congenital or 
degenerative disorders, nor birth trauma, but may include brain 
injuries caused by anoxia due to near drowning.
    3. Survivor: For purposes of this grant program the term 
``survivor'' refers to a person who has sustained and has survived a 
traumatic brain injury.
    4. Person-and family-centered care: For purposes of this grant 
program ``person-and family-centered care'' requires: involvement of 
survivors and their families in all phases of the TBI continuum of 
care; clear and continuous communication between family members and the 
care team; attention to the psychosocial needs of survivors and family 
members; and cultural competence of providers.

[[Page 14686]]

    5. Core Capacity: Core capacity includes 4 components: (1) a 
statewide TBI Advisory Board which meets the requirements set forth 
earlier in this Notice; (2) designation of a State agency and a 
designated staff position responsible for State TBI activities; (3) a 
Statewide needs assessment of the full spectrum of care/services from 
initial acute treatment through community reintegration for individuals 
with TBI; and (4) a Statewide action plan to develop a comprehensive, 
community-based system of care that encompasses physical, 
psychological, educational, vocational, and social aspects of TBI 
services and addresses the needs of the family as well as the TBI 
survivor.

Eligible Applicants

    Only State governments are eligible to apply for funding under the 
TBI demonstration grant program. The application for implementation 
funds may only come from the State agency designated as the lead for 
TBI services, while planning grant applications may emanate from an 
agency or office within the State responsible for planning and/or 
program coordination. The involvement of the State MCH program in both 
grant categories is expected.
    Only one application from each State may enter the review process 
and be considered for an award under this program.

Funding Categories

    Approximately $2.8 million will be available in FY 1997 to fund two 
categories of grants--Category 1: State planning grants; and Category 
2: State implementation grants.
    The major funding emphasis is on implementation activities which 
will move States toward Statewide systems that assure access to 
comprehensive and coordinated TBI services. It is recognized, however, 
that States are in different stages of development and that some will 
need assistance in establishing infrastructure as a prerequisite to 
implementation. Therefore, planning grants, as well as implementation 
grants, are being offered.
    Applicants may apply for either Category 1 or Category 2 funding as 
appropriate, but not both.

Category (1): State Planning Grants

    Planning grants are intended to support the development of 4 State 
level core capacity components to provide TBI services (see DEFINITIONS 
section, above). States may apply for a planning grant for one year. Up 
to 15 planning grants will be awarded. Planning grants will range from 
$20,000 to $75,000 per year. States should apply for an amount within 
that range which is appropriate to their needs in establishing full 
core capacity.

Category (2): State Implementation Grants

    Implementation grants are intended for States that have the 4 core 
capacity components in place. These grants will support activities that 
represent the next logical step(s) in building a Statewide system to 
assure access to comprehensive and coordinated TBI services.
    Implementation grants can address a wide range of activities and 
should reflect gaps or needed system enhancements identified through 
the Statewide TBI needs assessment. The grant may be used for Statewide 
implementation or targeted implementation in a specific locality within 
the State prior to Statewide implementation. Proposals under this 
category may address one or more of the following:

--Develop and implement protocols for point of entry personnel to 
improve early identification and appropriate triage, care and 
management of patients.
--Develop a replicable, pre-discharge model to be used in acute care 
sites in the development of long term resource plans for TBI survivors. 
Such a model should include person- and family-centered care 
coordination and resource management services.
--Develop and implement a plan to increase the number of public and 
private payers, including major managed care plans in the State, which 
will coordinate financial resources to provide services that most 
effectively meet the needs of TBI survivors.
--Improve data collection through: linking existing data systems; 
improving information on currently underserved populations; or 
improving ongoing tracking of service needs, patient outcomes, or 
program evaluation.
--Develop and implement education and training programs to address 
various stages of recovery along the continuum of care (acute care, 
rehabilitation, education, vocational, psychosocial, long term care and 
community reintegration) for survivors, families, and/or professionals. 
Such programs are expected to recognize culturally diverse populations, 
address currently underserved populations, and promote person- and 
family-centered care.
--Develop (or translate), implement and evaluate materials specifically 
directed at TBI survivors and their families to meet the specific needs 
of low literacy and culturally or ethnically distinct populations.
--Increase interagency collaboration and linkages to improve access to 
comprehensive individual and family-centered services along the 
continuum of care.

    Up to 8 State implementation grants, not to exceed $200,000 per 
grant for a one-year period, will be awarded in FY 1997. The planned 
project period for State implementation grants is one year.
    Applicants should be aware that, at present, funding for this 
program is available only for one year. Therefore, applicants must 
clearly identify the accomplishments they can achieve in one year's 
time and identify approaches that could be used to continue activities 
in the absence of future Federal funding. If additional Federal funds 
become available in the next fiscal year, planning grants will be 
considered for renewal for up to an additional year and implementation 
grants will be considered for renewal for an additional two years. If 
applicants will require greater than one year to complete their 
projects,they should include proposed plans for their second and third 
years of funding in their applications.

Special Concerns

    HRSA's Maternal and Child Health Bureau places special emphasis on 
improving service delivery to people from communities with limited 
access to comprehensive care. In order to assure access and cultural 
competence, projects must 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.

Evaluation Protocol

    A project awarded as part of the TBI Demonstration Grants program 
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 grant activities, the 
project goals, and the evaluation measures. Wherever

[[Page 14687]]

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 may not be 
funded.

Project Review and Funding

    The Department will review applications in the preceding categories 
as competing applications and will fund those which, in the 
Department's view, are consistent with the statutory purpose of the 
program, which best promote a comprehensive and coordinated system that 
assures access to appropriate care for TBI survivors and their 
families, and which address achievement of applicable Healthy People 
2000 objectives related to chronic disabling conditions and secondary 
injury prevention.

Review Criteria

    Specific review criteria have been established for each of the two 
TBI demonstration grant categories as follows:

Category 1: State Planning Grants

--The strength of the required Statewide Advisory Board as evidenced 
by:
    --The composition of the Board.
    --Commitments from all identified organizations or individuals.
    --Organizational and meeting arrangements.

--The adequacy of the State's proposed method for developing a 
Statewide needs assessment that includes--and a plan of action that 
emphasizes--the physical, psychosocial, educational, vocational and 
social needs of TBI survivors and their families.
--The adequacy of the State's proposed method for linking its plan of 
action to the findings of the Statewide needs assessment.
--The extent to which the proposal reflects the involvement of 
necessary public/private organizations and agencies to assure a 
comprehensive approach.
--The qualifications and experience established for the designated lead 
person for TBI within the State.
--The reasonableness of the proposed budget, soundness of the 
arrangements for fiscal management, effectiveness of use of personnel 
and likelihood of project completion within the proposed grant period.
--The adequacy of proposed methodology to assure full core capacity is 
developed during the grant period.

Category 2: State Implementation Grants

--The adequacy of the State's evidence that the four components for 
core capacity are in place.
--The relevance of the goals and objectives to the identified needs 
described in the Statewide needs assessment.
--The soundness of the plan for evaluating progress in achieving 
project objectives and outcomes.
--The adequacy of the plan for organizing and carrying out the project, 
including: (a) Reasonableness of proposed budget and soundness of the 
plan for fiscal management; (b) adequacy of proposed methodology for 
achieving project goals and outcome objectives; and (c) qualifications 
and experience of the Project Director and staff.
--The extent to which the involvement and participation of TBI 
survivors, families and organizations are considered in project 
implementation.
--Extent of collaboration and coordination among the entities in the 
TBI continuum identified by the State as necessary to carry out the 
proposed plan.
--The extent to which the project involves a multi-disciplinary and 
multi-system approach to TBI development.
--Adequacy of the plan for sustaining the proposed project.

Allowable Costs

    The HRSA may support reasonable and necessary costs of TBI 
Demonstration Grant projects within the scope of approved projects. 
Allowable costs may include salaries, equipment and supplies, travel, 
contracts, consultants, and others, as well as indirect costs as 
negotiated. The HRSA adheres to administrative standards reflected in 
the Code of Federal Regulations, 45 CFR Part 92 and 45 CFR Part 74.

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. (See Part 
148, Intergovernmental Review of PHS Programs under 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 is 93.TBA-1.

    Dated: March 21, 1997.
Claude Earl Fox, M.D., M.P.H.,
Acting Administrator.
[FR Doc. 97-7727 Filed 3-26-97; 8:45 am]
BILLING CODE 4160-15-P