[Federal Register Volume 65, Number 55 (Tuesday, March 21, 2000)]
[Notices]
[Pages 15159-15163]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-6897]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Office of Minority Health; Availability of Funds for Grants for 
the Bilingual/Bicultural Service Demonstration Grant Program

AGENCY: Office of the Secretary, Office of Minority Health.

ACTION: Notice of Availability of Funds and Request for Applications 
for the Bilingual/Bicultural Service Demonstration Grant Program.

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    Authority: This program is authorized under section 1707(e)(1) 
of the Public Health Service Act, as amended by Public Law 105-392.

Purpose

    The purpose of this Fiscal Year 2000 Bilingual/Bicultural Service 
Demonstration Grant Program is to:
    (1) Improve and expand the capacity for linguistic and cultural 
competence of health care professionals and paraprofessionals working 
with limited-English-proficient (LEP) minority communities; and
    (2) Improve the accessibility and utilization of health care 
services among the LEP minority populations.

[[Page 15160]]

    These grants are intended to demonstrate the merit of programs that 
involve partnerships between minority community-based organizations and 
health care facilities in a collaborative effort to address cultural 
and linguistic barriers to effective health care service delivery and 
to increase access to effective health care for the LEP minority 
populations living in the United States.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2010, a PHS-led national activity announced in January 2000 to 
eliminate health disparities and improve years and quality of life. 
More information on the Health People 2010 objectives may be found on 
the Healthy People 2010 web site: http://www.health.gov/healthy people. 
Copies of the Healthy People 2010: Conference Edition Volumes I and II 
can be purchased by calling (301) 468-5960 (cost $22.00). Another 
reference is the Healthy People 2000 Review-1998-99. One free copy may 
be obtained from the National Center for Health Statistics (NCHS), 6525 
Belcrest Road, Room 1064, Hyattsville, MD 20782 or telephone (301) 436-
8500 (DHHS Publication No. (PHS) 99-1256). This document may also be 
downloaded from the NCHS web site http://www.cdc.gov/nchs.

Background

    Large numbers of LEP minorities are linguistically isolated. 
According to the 1990 U.S. Census, 31.8 million persons or 13 percent 
of the total U.S. population (ages 5 and above) speak a language other 
than English at home. Almost 2 million people do not speak English at 
all and 4.8 million people do not speak English well. The 1990 U.S. 
Census also found that various minority populations and subgroups are 
linguistically isolated: approximately 4 million Hispanics; 
approximately 1.6 million Asians and Pacific Islanders; approximately 
282,000 Blacks; and approximately 77,000 Native Americans and Alaska 
Natives.
    Research has suggested that culture provides a unique concept of 
disease, risk factors, and preventive actions.\1\ Definitions of health 
and illness are often culturally determined and therefore, the study of 
culture and tradition is a valuable tool in understanding the 
underlying motives for health behavior.\2\ The clients' understanding 
of the Western health care model and their cultural beliefs, influence 
their access to health care services, the acceptance of health 
education, and their compliance with health care advice.
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    \1\ Evans, P.E. (1988) Minorities and AIDS. Health Education 
Research, Vol 3, No. 1, pp 113-115
    \2\ Toumishey, H. (1993), Multicultural Health Care: An 
Introductory Course. In R. Masi, L. Mensah, & K. McLeod (eds.), 
Health and Cultures: Exploring the Relationships, pp 113-138. Mosaic 
Press, Ontario, Canada
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    Rural populations must contend with several characteristics that 
further exacerbate their health care needs. These include an uneven 
pattern of disease burden and an acute lack of health care resources 
compared to urban places. A little over 62 percent of all non-
metropolitan counties are designated by DHHS as Primary Care Health 
Professional Shortage Areas.\3\
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    \3\ North Carolina Rural Health Research and Policy Analysis 
Center (1998), The University of North Carolina at Chapel Hill in 
Mapping Rural Health: The Geography of Health Care and Health 
Resources in Rural America.
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    In FY 1993, the Office of Minority Health (OMH) launched the 
Bilingual/Bicultural Service Demonstration Grant Program to address the 
linguistic, cultural and social barriers the LEP minority populations 
encounter when accessing health services. In addition, the program 
recognized other factors which contribute to the poor health status of 
LEP minorities including:
     Inadequate number of health care providers and other 
health care professionals skilled in culturally competent and 
linguistically appropriate delivery of services;
     Scarcity of trained interpreters at the community level;
     Deficiency of knowledge about appropriate mechanisms to 
address language barriers in health care settings;
     Absence of effective partnerships between major mainstream 
provider organizations and LEP minority communities;
     Geographic isolation;
     Low economic status;
     Lack of health insurance, and
     Organizational barriers.
    These barriers continue to impede the LEP populations' ability to 
access and attain quality health care. Therefore it is essential that 
care providers, health care professionals and other staff become 
informed about the diverse linguistic, cultural and medical 
perspectives of their clientele. Enhancement of cultural competency 
among these individuals should increase LEP minority populations' 
knowledge of the Western health care model, and increase their access 
to and willingness to accept appropriate health care. In FY 2000, the 
Bilingual/Bicultural program will concentrate on the Health People 2010 
Focus Areas, six of which the Surgeon General has identified as 
priorities: cardiovascular disease, child and adult immunizations, HIV/
AIDS, infant mortality, cancer screening and management, and diabetes.

Eligible Applicants

    Public and private, nonprofit minority community-based 
organizations. The minority community-based organization must serve a 
targeted LEP minority community and have an established linkage with a 
health care facility. The linkage between the community-based 
organization and the health care facility must be documented in writing 
as specified under the project requirements described in this 
announcement. Local affiliates of national organizations which have an 
established link with a health care facility are eligible to apply.
    National organizations are not eligible to apply. Other non-
eligible entities are for-profit hospitals, universities and schools of 
higher learning. Organizations are not eligible to receive funding from 
more than one OMH grant program concurrently.

Funding Preference

    There are rural areas which have much higher rates of illness and 
disease than non-rural areas. For instance, infant mortality rates 
(mirrored by birth weight rates) show a distinct regional distribution 
with up to 74.1 infant deaths per 1,000 births in rural and frontier 
counties.\4\ Morbidity rates for Hepatitis A and tuberculosis in the 
Border are much higher than the respective national rates.\5\ The OMH 
recognizes the special needs of minority LEP populations in certain 
geographic areas. To address these special needs, a preference in 
funding will be given to applications submitted by minority community-
based organizations located in border areas, frontier areas, and rural 
areas (see the definitions of these areas in this announcement). This 
preference will only be applies to applications that rank above the 
50th percentile of applications recommended for approval by the 
objective review committee.
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    \4\ Ibid.
    \5\ Border Issues (updated April 1997); United States-Mexico 
Chamber of Commerce web site http://www.usmcoc.org/borderl.html.
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Deadline

    To receive consideration, grant applications must be received by 
the OMH Grants Management Office by May 22, 2000. Applications will be 
considered as meeting the deadline if they are: (1) Received on or 
before the deadline date, or (2) postmarked on or before the deadline 
date and received in time for orderly processing. A legibly

[[Page 15161]]

dated receipt from a commercial carrier or U.S. Postal Service will be 
accepted in lieu of a postmark. Private metered postmarks will be 
accepted as proof of timely mailing. Applications submitted by 
facsimile transmission (FAX) or any other electronic format will not be 
accepted. Applications which do not meet the deadline will be 
considered late and will be returned to the applicant unread.

Addresses/Contacts

    Applications must be prepared using Form PHS 5161-1 (Revised June 
1999). Application kits and technical assistance on budget and business 
aspects of the application may be obtained from Ms. Carolyn A. 
Williams, Grants Management Officer, Division of Management Operations, 
Office of Minority Health, Rockwall II Building, Suite 1000, 5515 
Security Lane, Rockville, Maryland 20852, telephone (301) 594-0758. 
Completed applications are to be submitted to the same address.
    Questions regarding programmatic information and/or requests for 
technical assistance in the preparation of grant applications should be 
directed to Ms. Cynthia H. Amis, Director, Division of Program 
Operations, Office of Minority Health, Rockwall II Building, Suite 
1000, 5515 Security Lane, Rockville, Maryland 20852, telephone number 
(301) 594-0769.
    Technical assistance is also available through the OMH Regional 
Minority Health Consultants (RMHCs). A listing of the RMHCs and how 
they may be contacted will be provided in the grant application kit. 
Additionally, applicants can contact the OMH Resource Center (OMHRC) at 
1-800-444-6472 for health information.

Availability of Funds

    Approximately $1.5 million is available for award in FY 2000. It is 
projected that awards of up to $150,000 total costs (direct and 
indirect) for a 12-month period will be made to approximately 10 to 12 
competing applicants.

Period of Support

    The start date for the Bilingual/Bicultural Service Demonstration 
Program grants is September 30, 2000. Support may be requested for a 
total project period not to exceed 3 years. Noncompeting continuation 
awards of up to $150,000 will be made subject to satisfactory 
performance and availability of funds.

Definitions

    For purposes of this grant announcement, the following definitions 
apply:
    Border Area--The area lying 100 kilometers (62 miles) to the north 
of the 3,141 kilometer (1,952 mile) U.S.-Mexico boundary (as defined in 
Article 4 of the La Paz Agreement between the U.S. and the United 
Mexican States, entered into force February 16, 1984).
    Community-Based Organization--Public and private, nonprofit 
organizations which are representative of communities or significant 
segments of communities, and which address health and human services.
    Cultural Competency--a set interpersonal skills that allow 
individuals to increase their understanding and appreciation of 
cultural differences and similarities within, among and between groups. 
This requires a willingness and ability to draw on community-based 
values, traditions and customs, and to work with knowledgeable persons 
of and from the community in developing focused interventions, 
communications and other supports. (Orlandi, Mario A., 1992.)
    Health Care Facility--a public nonprofit facility that has an 
established record for providing comprehensive health care services to 
a targeted, LEP racial/ethnic minority community. Facilities providing 
only screening and referral activities are not included in this 
definition. A health care facility may be a hospital, outpatient 
medical facility, community health center, migrant health center, or a 
mental health center.
    Frontier Area--an area (borough, county or parish) with 6 or fewer 
persons per square mile.
    Limited-English-Proficient Populations (LEP)--individuals (as 
defined in Minority Populations below) with a primary language other 
than English who must communicate in that language if the individual is 
to have an equal opportunity to participate effectively in and benefit 
from any aid, service or benefit provided by the health provider.
    Minority Community-Based Organization--a public or private 
nonprofit community-based minority organization or a local affiliate of 
a national minority organization that has: a governing board composed 
of 51 percent or more racial/ethnic minority members, a significant 
number of minorities employed in key program positions, and an 
established record of service to a racial/ethnic minority community.
    Minority Populations--American Indian or Alaska Native, Asian, 
Black or African American, Hispanic or Latino, and Native Hawaiian or 
other Pacific Islander. (Revision to the Standards for the 
Classification of Federal Data on Race and Ethnicity, Federal Register, 
Vol. 62, No. 210, pg. 58782, October 30, 1997)
    Rural Area--a borough, county or parish with a population less than 
50,000 that is not included in a Metropolitan Statistical Area (MSA) as 
defined by the Office of Management and Budget.

Project Requirements

    Each project funded under this demonstration grant must address all 
of the following requirements.
    1. Address at least one, but no more than three of the health focus 
areas referenced in the Background section of this announcement.
    2. Carry out activities to improve and expand the capacity of 
health care providers and other health care professionals to deliver 
linguistically and culturally competent health care services to the 
target population. Potential activities may include: language and 
cultural competency training and curricula development; health 
promotion or health service access information in the native language 
of the target population; on-site interpretation services; or training 
products such as CD-ROMs, video tapes, or on-line distance based 
learning formats for continuing education.
    3. Carry out activities to improve access to health care for the 
LEP population. Potential activities may include those that will: 
Educate the target population on the importance of health promotion and 
disease prevention; enhance the ability of the target population to 
communicate their health care concerns to health care providers; 
increase their understanding of health education information; and 
improve compliance with health care treatments. The applicant may 
utilize culturally and/or linguistically appropriate information or 
methods of communication, such as printed materials with pictorial 
messages, mass media, public service announcements and neighborhood 
outreach as educational tools. Forums, seminars or workshops to promote 
information exchange among the targeted LEP population and the health 
care professionals may also be considered activities for the education 
of both groups.
    4. Have an established, formal linkage between the minority 
community-based organization and a health care facility,

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prior to submission of an application. The linkage must be confirmed by 
a signed agreement between the applicant organization and the health 
care facility which specifies in detail the roles and resources that 
each entity will bring to the project, and state the duration and terms 
of the linkage. The document must be signed by individuals with the 
authority to represent the organization (e.g., president, chief 
executive officer, executive director).

Use of Grant Funds

    Budgets of up to $150,000 total cost (direct and indirect) per year 
may be requested to cover costs of: personnel, consultants, supplies 
(including screening and outreach supplies), equipment, and grant-
related travel. Funds may not be used for medical treatment, 
construction, building alterations, or renovations. All budget requests 
must be fully justified in terms of the proposed goals and objectives 
and include a computational explanation of how costs were determined.

Criteria for Evaluating Applications

    Review of Applications: Applications will be screened upon receipt. 
Those that are judged to be incomplete, non-responsive to the 
announcement or nonconforming will be returned without comment. Each 
organization may submit no more than one proposal under this 
announcement. If an organization submits more than one proposal, all 
will be deemed ineligible and returned without comment. Accepted 
applications will be reviewed for technical merit in accordance with 
PHS policies. Applications will be evaluated by an Objective Review 
Panel chosen for their expertise in minority health and their 
understanding of the unique health problems and related issues 
confronted by the racial/ethnic minority populations in the United 
States.
    Applicants are advised to pay close attention to the specific 
program guidelines and general and supplemental instructions provided 
in the application kit.
    Application Review Criteria: The technical review of applications 
will consider the following generic factors:

Factor 1: Background (15%)

    Adequacy of: Demonstrated knowledge of the problem at the local 
level; demonstrated need within the proposed community and target 
population; demonstrated support and established linkage(s) in order to 
conduct the proposed model; and extent and documented outcome of past 
efforts and activities with the target population.

Factor 2: Objectives (15%)

    Merit of the objectives, their relevance to the program purpose and 
stated problem, and their attainability in the stated time frames.

Factor 3: Methodology (35%)

    Appropriateness of proposed approach and specific activities for 
each objective. Logic and sequencing of the planned approaches in 
relation to the objectives and program evaluation. Soundness of the 
established linkages.

Factor 4: Evaluation (20%)

    Thoroughness, feasibility and appropriateness of the evaluation 
design, and data collection and analysis procedures. Potential for 
replication of the project for similar target populations and 
communities.

Factor 5: Management Plan (15%)

    Applicant organization's capability to manage and evaluate the 
project as determined by: the qualification of proposed staff or 
requirements for ``to be hired'' staff; proposed staff level of effort; 
management experience of the lead agency; and experience of each member 
of the linkage as it relates to its defined roles and the project.

Award Criteria

    Funding decisions will be determined by the Deputy Assistant 
Secretary of Minority Health, Office of Minority Health, and will take 
under consideration: the recommendations and ratings of the review 
panel; the funding preference; geographic and racial/ethnic 
distribution; and health problem areas having the greatest impact on 
minority health. Consideration will be given to projects proposed to be 
implemented in Empowerment Zones and Enterprise Communities.

Reporting and Other Requirements

General Reporting Requirements

    A successful applicant under this notice will submit: (1) Bi-annual 
progress reports; (2) an annual Financial Status Report, and (3) a 
final progress report and final Financial Status Report in the format 
established by the Office of Minority Health, in accordance with 
provisions of the general regulations which apply under ``Monitoring 
and Reporting Program Performance,'' 45 CFR Part 74, Subpart J.

Provision of Smoke-Free Workplace and Nonuse of Tobacco Products by 
Recipients of PHS Grants

    The Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and to promote the nonuse 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.

Public Health System Reporting Requirements

    This program is subject to Public Health Systems Reporting 
Requirements. Under these requirements, a 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.
    Community-based, nongovernmental applicants are required to submit, 
no later than the Federal due date for receipt of the application, the 
following information to the head of the appropriate state and local 
health agencies in the area(s) to be impacted: (a) a copy of the face 
page of the applications (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. Copies of the letters 
forwarding the PHSIS to these authorities must be contained in the 
application materials submitted to the Office of Minority Health.

State Reviews

    This program is subject to the requirements of Executive Order 
12372 which allows States the option of setting up a system for 
reviewing applications from within their States for assistance under 
certain Federal programs. The application kit to be made available 
under this notice will contain a listing of States which have chosen to 
set up a review system and will include a State Single Point of Contact 
(SPOC) in the State for review. Applicants (other than federally 
recognized Indian tribes) should contact their SPOCs as early as

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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 by the Office 
of Minority Health's Grants Management Officer. The Office of Minority 
Health does not guarantee that it will accommodate or explain its 
responses to State process recommendations received after that date. 
(See ``Intergovernmental Review of Federal Programs,'' Executive Order 
12372, and 45 CFR Part 100 for a description of the review process and 
requirements.)

OMB Catalog of Federal Domestic Assistance

    The OMB Catalog of Federal Domestic Assistance Number for the 
Bilingual and Bicultural Service Demonstration Program is 93.105.

    Dated: March 14, 2000.
Nathan Stinson, Jr.,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 00-6897 Filed 3-20-00; 8:45 am]
BILLING CODE 4160-17-M