[Federal Register Volume 65, Number 24 (Friday, February 4, 2000)]
[Notices]
[Pages 5647-5649]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-2567]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Availability of Funds for Grants for the Community Access Program
AGENCY: Health Resources and Services Administration, HHS.
ACTION: Notice of availability of funds.
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SUMMARY: The Health Resources and Services Administration (HRSA)
announces the availability of $25 million to assist communities and
their safety net providers in developing integrated health care
delivery systems that serve the uninsured and underinsured with greater
efficiency and improved quality of care. The $25 million in available
funding has been appropriated under the FY 2000 HHS Appropriations Act.
In FY 2000, HRSA will provide funding for approximately 20
communities to further their development of integrated delivery systems
for the uninsured and underinsured. Grants will vary in size, based on
the scope of the project and the size of the service area.
During the first year of funding for this program, HRSA will
support infrastructure development in communities that have already
begun to reorganize and integrate their health care delivery systems.
FY 2000 funding is not intended to support those communities that have
not yet begun the planning and development of necessary organizational
structure.
Up to 100 communities may ultimately be funded as part of this
national program targeted by the Administration to spend $1 billion
over five years. FY 2000 funded communities may be eligible for
available FY 2001 funding (assuming continued appropriations) to
support further infrastructure development and filling service gaps. In
addition, using the experiences of the FY 2000 funded communities as
potential models for adaptation, FY 2001 funding is anticipated for
support of new communities for planning and system development. Thus,
communities that have not yet begun the planning and development of
necessary organizational structure should have an opportunity to apply
in FY 2001.
Over the years that the program is funded, funds are anticipated to
be available to fill service gaps within coordinated systems of care.
This program shares some of the same goals of the W.K. Kellogg
Foundation's Community Voices Program and the Robert Wood Johnson
Foundation's Communities in Charge Program. Thus, CAP will take into
account the experiences of these foundations as well as other programs
that promote the integration of services to the uninsured and
underinsured.
DATES: The timeline for application submission, review, and award are
as follows:
February 10, 2000: Application kits and additional guidance will be
available through the HRSA Grants Application Center (GAC).
March 7-16, 2000: There will be a series of six pre-application
workshops conducted across the country: Boston, MA--March 7, 2000;
Atlanta, GA--March 8, 2000; Chicago, IL--March 9, 2000; Dallas, TX--
March 14, 2000; Los Angeles, CA--March 15, 2000; Seattle, WA March 16,
2000.
June 1, 2000: Applications due.
July 3-17, 2000: Applications reviewed.
August 2000: Site visits to selected applicants.
September 2000: Grant awards announced.
ADDRESSES: To receive a complete application kit (i.e., application
instructions, necessary forms, and application review criteria),
contact the HRSA GAC at: HRSA GAC, 1815 N. Fort Meyer Drive, Suite 300,
Arlington, VA 22209, Phone: 1-877-HRSA-123, Fax: 1-877-HRSA-345, E-
Mail: [email protected]
FOR FURTHER INFORMATION CONTACT: For further information, contact the
Community Access Program Office: Community Access Program Office,
Health Resources and Services Administration, Parklawn Building, Suite
9A-30, 5600 Fishers Lane, Rockville, MD 20857, Phone: (301) 443-0536,
Fax: (301) 443-0248.
SUPPLEMENTARY INFORMATION: In 1998, 44.5 million people in the United
States did not have health insurance. Of these, 24.6 million were
employed--18.7 million worked full time and 5.9 million worked part
time.
The uninsured and underinsured often have complex medical needs,
remain outside organized systems of care, and have insufficient
resources to obtain care. They may defer care or not receive needed
services, and they are about half as likely to receive a routine check-
up as insured adults. The uninsured and underinsured also rely heavily
on expensive emergency rooms, and because they lack a routine source of
care, they often do not receive needed follow-up services.
Many of the uninsured and underinsured rely on the nation's
institutions, systems, and individual health professionals that provide
a significant volume of health care services without regard for ability
to pay. In many communities, these providers are struggling to care for
the increasing numbers of uninsured and underinsured individuals. They
face many challenges such as an uneven distribution of the burden of
uncompensated care, the fragmentation of services for the uninsured,
insufficient numbers of certain types of providers, reduced Medicaid
revenues, and a growing need for mental health and substance abuse
services.
While integration among these providers is critical to serve the
uninsured and underinsured with greater efficiency and to improve
quality of care, many of these providers are so pressured by basic
caregiving tasks, that they need assistance to coordinate their efforts
with other providers and to develop integrated community-based systems
of care.
The Community Access Program
Program Purpose
The purpose of this program is to assist communities and consortia
of
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health care providers to develop the infrastructure necessary to fully
develop or strengthen integrated health systems of care that coordinate
health services for the uninsured and underinsured.
Program Goal
The coordination of services through the CAP grant will allow the
uninsured and underinsured to receive efficient and higher quality care
and gain entry into a comprehensive system of care. The system will be
characterized by effective collaboration, information sharing, and
clinical and financial coordination among all levels of care in the
community network. The system will be committed to continuous
performance improvement, implementation of best practices, staff
development, and real-time feedback of outcomes of care. Care
management (e.g., case, disease) will be applied across the continuum
for those with chronic illnesses, high-risk individuals, and high
utilizers. The system will also strive to provide universal access to
the target population, and to improve the health status of the
community population.
This vision requires a re-thinking of the relationships,
priorities, and desired outcomes for local or regional care delivery.
It means adopting the philosophy that care for the ill and injured
occurs within the context of a comprehensive system design of
population health improvement.
The community being served should be actively involved in the
system design. Broad understanding, two-way learning between providers
and community, and participation in priority setting and governance by
the community are essential components of this vision. This will reduce
out migration for services in rural areas and assure sustainability of
the system.
Program Description
In implementing a system of coordinated care for the uninsured and
underinsured in a community, we are seeking to fund a variety of
program models in communities that have an established track record for
building partnerships and that have completed the basic planning
necessary to implement a system. The successful applicant will design a
program that builds upon its current capacities and strengths; brings
the major players in the political and health delivery systems to the
table; uses the federal funds available to plan a transition to an
expanded and innovative approach that will ultimately be competitive
within its own market; and, in any event, will sustain the delivery of
services and funding after these federal grants no longer exist. The
successful applicant will work with its county board, city council,
state legislature, and state health programs to assure the coordination
and efficient use of all available resources to achieve program goals.
There is no one successful model that we are trying to replicate.
Rather, there are several models that already exist and that each
community may draw from in creating a program to address its own needs.
In surveying innovative community approaches to the provision of
safety net services, we have come across communities that have:
combined the development of managed care networks for the
indigent funded through local tax increases and the redirection of
funds towards the care network and away from the support of tertiary
care at public hospitals;
Redistributed caseload to private providers because of the
forced closure of public hospitals;
Coordinated the provision of care through public
hospitals, public health departments, and community health centers;
Linked hospital and clinic services through state of the
art data systems and are able to create seamless transitions between
Medicaid, uninsured, and insured status for low income populations;
Linked behavioral and acute care service provision; and
Created networks to allocate uncompensated ambulatory care
loads among physicians.
We are looking for applicants with clear goals, an operational plan
for meeting those goals, a history of commitment to serving indigent
populations, and enough of a track record to indicate a fair chance at
being successful. Innovative proposals for sustaining the service
delivery component of projects could include state redirection of DSH
funds or general assistance funds, creative use of local or state
taxing authorities, use of tobacco settlement funds, and creative
partnerships with the provider and business communities. Applications
will be judged from the perspective of whether the financing proposed
is realistic--given state and community resources--and appropriate to
the project proposed.
Funded Projects Will Contain Several Common Elements
Community Need: Communities funded through this program will have
high or increasing rates of uninsured and underinsured and will have
identified specific organizational needs within existing delivery
systems. A ``community'' for the purpose of this program may be based
on geography or a population group (e.g., the homeless) as defined by
the people in the community.
Collaboration Among Safety Net Providers: The proposed system
should build upon current investments in communities for serving these
populations and include the safety net providers who have traditionally
provided services without regard to the ability to pay. The coalition
should be built upon formal arrangements among the partners that define
the extent of the commitment and involvement in policy development and
decision-making from each partner.
Comprehensive Services: The proposed system will include all
partners necessary to assure access to a full range of services,
including mental health and substance abuse treatment. It is
anticipated that the health services (prevention, primary, and
specialty) provided by Federally-supported programs that are present in
the community will be part of this coalition of providers.
Coordination with Public Insurance Programs: The proposed system
will demonstrate coordination with state (e.g., memorandum of
agreements) programs to ensure that eligible beneficiaries are enrolled
in public insurance programs (e.g., S-CHIP, Medicaid).
Community Involvement: There is strong community support for these
efforts that provide a broad foundation of assistance to the provider
community undertaking this project. Management and governance
structures are in place that assure accountability to funders and
define the community role in setting policy. The community involvement
in the development, implementation, and governance of the project will
be evident. This should include the leadership within the appropriate
legislative and executive bodies, providers identified above, health
plans and payers, and community leaders.
Sustainability: A plan for long-term sustainability is designed and
has community consensus. There is evidence that the program is capable
of leveraging other sources of funds and integrating current funding
sources in a way to assure long-term sustainability of the project.
Eligible Applicants
To encourage the development of various types of system integration
models, this program seeks a variety of
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applicants representing all types of communities. Applicants who
receive funding may be large health care systems or small
organizations. Applications are encouraged from large urban areas,
small rural communities, and tribal organizations.
Applications may be submitted by public, private, and non-profit
entities that demonstrate a commitment to and experience with providing
a continuum of care to uninsured individuals. Each applicant must
represent a community-wide coalition that is committed to the project
and includes safety net providers (where they exist) who have
traditionally provided care to the community's uninsured and
underinsured regardless of ability to pay. The community-wide coalition
must consist of partners from all levels of care (i.e., primary,
secondary, tertiary) and partners who represent a range of services
(e.g., mental health and substance abuse treatment, maternal and child
health care, oral health, HIV/AIDS).
Examples of eligible applicants who may apply on behalf of the
community-wide coalition include but are not limited to:
A consortium or network of providers (e.g., public and
charitable hospitals; community, migrant, homeless, public housing, and
school-based health centers; rural health clinics; free health clinics;
teaching hospitals and health professions education schools)
Local government agencies (e.g., local public health
departments with service delivery components)
Tribal governments
Managed care plans or other payers (e.g., HMOs, insurance
companies)
Agencies of State governments, multi-state health systems, or
special interest groups may submit applications on behalf of multiple
communities if they demonstrate the ability to coordinate community
health care delivery systems and bring resources to the community.
Competing applications for the same patient population will not be
considered for funding; therefore, applicants from the same community
are required to collaborate.
Funding Criteria
Review criteria that will be used to evaluate applications
include:
Evidence of progress towards integration prior to
application for funding
Evidence that the target population has a high or
increasing rate of uninsurance
Evidence of established partnerships among a broad-based
community consortium
Appropriateness and quality of clinical services to be
provided
Commitments from local government agencies, public and
private health care providers, community leaders
Demonstration of existing and sustainable public and
private funding sources
Accountable management and budget plan
Commitment to self evaluation and participation in a
national evaluation
Program Expectations
Funding through this initiative may be used to support a variety of
projects that would improve access to all levels of care for the
uninsured and underinsured. While each community should design a
program that best addresses the needs of the uninsured and
underinsured, and the providers in their community, funding is intended
to encourage safety net providers to develop coordinated care systems
for the community's uninsured and underinsured.
Examples of activities that could be supported with this funding
include:
Offering a comprehensive delivery system for the uninsured
and underinsured through a network of safety net providers. [Single
registration, eligibility systems]
Integrating preventive, mental health, substance abuse,
HIV/AIDS, and maternal and child health services within the system.
[Block grant funded services, other DHHS programs, state and local
programs]
Developing a shared information system among the
community's safety net providers. [Tracking, case management, medical
records, financial records]
Developing and incorporating shared clinical protocols,
quality improvement systems, utilization management systems, and error
prevention systems.
Sharing core management functions. [Finance, purchasing,
appointment systems]
Coordinating and strengthening priority services to
specific targeted patient groups.
Developing affordable pharmaceutical services.
Use of Grant Funds
Funding provided through this program may NOT be used to substitute
for or duplicate funds currently supporting similar activities. Grant
funds may support costs such as:
Project staff salaries
Consultant support
Management information systems (e.g., hardware and
software)
Project-related travel
Other direct expenses necessary for the integration of
administrative, clinical, information system, or financial functions
Program evaluation activities
With appropriate justification on why funds are needed to support
the following costs, up to 15 percent of grant funds may be used for:
Alteration or renovation of facilities
Primary care site development
Service expansions or direct patient care
Grant funds may NOT be used for:
Construction
Reserve requirements for state insurance licensure
Expected Results
The integration and coordination of services among a community's
safety net providers are expected to result in:
A system of care that provides coordinated coverage to the
target population.
Increased access to primary care resulting in a reduction
in hospital admissions for ambulatory sensitive conditions among the
uninsured and underinsured.
Elimination of unnecessary, duplicate functions in service
delivery and administrative functions, resulting in savings to reinvest
in the system.
Increased numbers of low-income uninsured people with
access to a full range of health services.
Dated: January 31, 2000.
Claude Earl Fox,
Administrator.
[FR Doc. 00-2567 Filed 2-3-00; 8:45 am]
BILLING CODE 4160-15-U