[Federal Register Volume 65, Number 97 (Thursday, May 18, 2000)]
[Notices]
[Pages 31553-31557]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-12462]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Office of Public Health and Science; Availability of Funds and 
Requests for Applications for Cooperative Agreements for the National 
Community Centers of Excellence (CCOE) in Women's Health Program

AGENCY: Office of the Secretary, Office of Public Health and Science, 
Office on Women's Health.

Purpose

    To provide recognition and funding to community-based programs that 
unite promising approaches in women's health across five components: 
(1) Comprehensive health service delivery, (2) training for lay and 
professional health providers, (3) community-based research, (4) public 
education/outreach, and (5) leadership development for women as health 
care consumers and providers. The focus of the CCOE initiative is not 
to develop new programs or to fund direct service or research, but 
rather to integrate, coordinate, and strengthen linkages between 
activities that are already underway in the community in order to 
reduce fragmentation in women's health services and activities. Another 
major purpose of the CCOE program is to foster the replication of 
promising models and strategies that coordinate and integrate women's 
health activities at the community level and improve health outcomes 
for underserved women.
    The CCOE program addresses women's health from a women-centered, 
holistic, multi-disciplinary, and community-based perspective (see 
definitions below). Women's health issues are defined in the context of 
women's lives, including their multiple social roles and the importance 
of relationships with other people to their lives. This definition of 
women's health encompasses both mental and physical health (including 
oral health) and spans the life course.
    The CCOE program will operate under cooperative agreements, to 
allow a collaborative relationship between the CCOE and the federal 
agencies. The funding agencies of the Department of Health and Human 
Services (HHS) include the Office on Women's Health; the Office of 
Minority and Women's Health in the Bureau of Primary Health Care of the 
Health Resources and Services Administration; and the Office of 
Minority Health. These agencies will provide technical assistance and 
oversight as necessary for the implementation, conduct, and assessment 
of program activities.
    HHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2010. Emphasis will be placed 
on aligning activities and programs with the Healthy People 2010: Goal 
2--eliminating health disparities due to age, gender, race/ethnicity, 
education, income, disability, living in rural localities, or sexual 
orientation. More information on the Healthy People 2010 objectives may 
be found on the Health People 2010 web site: http://www.health.gov/healthypeople. Copies of the Healthy People 2010: Conference Edition 
Volumes I and II can be purchased by calling (301) 468-5960 (cost 
$22.00). The reference document entitled ``Healthy People 2010: 
Understanding and Improving Health'' is available for $9.00. 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.

Program Goals

    1. Reducing the fragmentation of services and access barriers that 
women encounter by providing a framework for the coordination and 
integration of comprehensive health services with research, training, 
and leadership

[[Page 31554]]

activities in the community to advance women's health.
    2. Creating healthier communities with a more integrated and 
coordinated infrastructure for women's health targeted at underserved 
women.
    3. Empowering underserved women as health care consumers and 
decision-makers.
    4. Increasing the women's health knowledge base with rigorous, 
community-based research that reflects the health needs and issues of 
underserved women.
    5. Increasing the number of health professionals who have training 
in working with underserved communities, boosting the number of girls 
who pursue health careers, and increasing the leadership skills and 
opportunities for women in the community and those who provide health 
services to the community.
    6. Spreading the successes of model women's health strategies and 
new innovations to communities across the country.
    7. Eliminating health disparities for women who are underserved due 
to age, gender, race/ethnicity, education, income, disability, living 
in rural localities, or sexual orientation.

Background

    The National Centers of Excellence in Women's Health (CoEs) have 
been functioning in academic health centers since 1996. The unique 
feature of the CoE program has been the way it has brought together the 
disparate set of women's health activities that take place in academic 
health centers: linking together women's health research, medical 
education, clinical services, community outreach, and leadership 
development for women in academic medicine to create a more dynamic and 
informed system of care. The primary role of the CoEs has been to unite 
women's health activities and programs, promote multi-disciplinary and 
cross-departmental collaborations, and institutionalize a more 
integrative approach to women's health in academic health centers. The 
success of the CoE model has been rooted in this integrative approach.
    The intent of the National Community Centers of Excellence in 
Women's Health Program (CCOE) is to maintain an emphasis on the 
linkage, coordination, and sharing of knowledge between different 
activities in women's health. Like the CoE program, the CCOE program 
will use an integrative approach, with the funding focused on linking 
activities rather than on creating new ones from the ground up. The 
CCOE program will adopt the components of the CoE Program (women's 
health research, health provider training, comprehensive clinical 
services, community outreach, and leadership development), but will 
focus on the community-based organization as the nucleus for 
operationalizing the new model. The CCOE program will also add a 
technical assistance component, so that the lessons learned from this 
unique model can be replicated in other communities around the country.
    The CCOE program will be distinct from the CoE program in two 
important ways:
    1. Applicants must be a community hospital, community health 
center, or other community-based organization. One award will be 
reserved for a community health center funded under Section 330 of the 
Public Health Service Act. Applications from academic health centers or 
organizations that are part of academic health centers will not be 
accepted as the CoE model is designed for such organizations.
    2. To increase the geographic range of the Center of Excellence 
model, applications will be accepted from organizations in all of the 
American States and Territories except those that currently have CoE 
programs including CA, CT, IL, IN, LA, MA, MI, NC, PA, PR, WA, and WI.
    As noted in Healthy People 2010, which outlines the health goals 
for our Nation, most successful community health initiatives involve 
multiple disciplines and interventions, linking community strengths and 
resources so that the whole is indeed greater than the sum of its 
parts. The CCOE program will link resources across women's health 
activities and disciplines to increase awareness/ knowledge, and to 
move women's health efforts forward more efficiently.

Eligible Applicants

    Applicants must be a public or private nonprofit community-based 
hospital, community health center, or community-based organization 
serving underserved women. Academic health centers or organizations 
that are part of academic health centers are not eligible for funds 
under this announcement. To increase the geographic range of the 
overall Center of Excellence model, applications will be accepted from 
organizations in all of the American States and Territories except 
those which already have a National Center of Excellence in Women's 
Health (CoE) program. Thus applications will not be accepted from 
programs in the following states: CA, CT, IL, IN, LA, MA, MI, NC, PA, 
PR, WA, WI. One award will be reserved for a community health center 
funded under section 330 of the Public Health Service Act.

Deadline

    To receive consideration, applications must be received by June 30, 
2000 at 2 p.m. (Eastern Time). 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 dated receipt from a 
commercial carrier or U.S. Postal Service will be accepted in lieu of a 
postmark. Private metered postmarks will not be accepted as proof of 
timely mailing. Application 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 questions regarding programmatic 
information and/or requests for technical assistance in the preparation 
of grant applications should be directed in writing to Ms. Anna 
Kindermann, Division of Program Management, Office on Women's Health, 
Parklawn Building, Room 16A-55, 5600 Fishers Lane, Rockville MD 20857, 
email: [email protected].
    Completed applications are to be submitted to: Ms. Anna Kindermann, 
Division of Program Management, Office on Women's Health, Parklawn 
Building, Room 16A-55, 5600 Fishers Lane, Rockville MD 20857.
    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, Office of Public Health and Science, Rockville, MD, 
20852, telephone (301) 594-0758, Ext. 157.

Availability of Funds

    Approximately $450,000 is available for award in FY 2000 under this 
announcement. 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 3 competing applicants.

Period of Support

    The start date for the cooperative agreement is September 30, 2000. 
Support may be requested for a total project period not to exceed 5 
years.

[[Page 31555]]

Noncompeting continuation awards of up to $150,000 will be made subject 
to satisfactory performance and availability of funds.

Use of Grant Funds

Project Requirements

    The major component of a CCOE program must consist of activities 
aimed at developing and strengthening a framework for bringing together 
a comprehensive array of services for women, and connecting those with 
promising strategies to: train a cadre of health care providers that 
are capable of addressing underserved women's health needs at the 
community level with an emphasis on prevention or moderation of illness 
or injury that appear controllable through individual knowledge and 
behavior; conduct participatory, community-based research in women's 
health; enhance public education and outreach activities in women's 
health with an emphasis on prevention or moderation of illness or 
injury that appear controllable through individual knowledge and 
behavior; and promote leadership/career development for women in the 
health professions and women/girls in the community. A project may 
develop outreach and education materials, training programs, and 
leadership development activities/materials. Award recipients must 
also, with input from community representatives, put into place and 
track a set of measurable objectives for improving health outcomes and 
decreasing health disparities for underserved women in the community.
    Each CCOE must also demonstrate an ability to foster the transfer 
of lessons learned and successful strategies. These may include either 
process-based lessons (for example: How to bring multiple community 
partners together) or outcomes-based lessons (for example: How to 
increase diabetes screening and control through improved outreach, 
education, and treatment). The CCOEs must foster the replication of 
promising models from their sites through activities such as showcasing 
them at meetings and workshops; providing direct technical assistance 
to other communities; developing replication guides/materials; and 
providing technical assistance to health professionals, directly or 
through their professional organizations, interested in working with 
under-served women in the community.

Use of Funds

    A majority (75%) of the funds from the CCOE award must be targeted 
at staffing and efforts aimed at coordinating and integrating the major 
components of the CCOE program. The remainder (25%) of the award 
funding must be targeted at staff and efforts to foster the transfer of 
lessons learned/successful strategies from the CCOE program.
    Funds may be used to cover costs of personnel, consultants, 
supplies (including screening, education, and outreach supplies), 
equipment, and grant related travel. Funds may not be used for 
construction, building alterations, medical treatment, 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. Accepted application will be reviewed 
for technical merit in accordance with PHS policies. Applications will 
be evaluated by a technical review panel composed of government experts 
in the fields of program management, community service delivery, 
community outreach, health education, community research, and community 
leadership development. Consideration will be given to applicants that 
demonstrate progress toward eliminating health disparities through the 
integration of services, research, education, training, and leadership/
career development. Preference will also be given to applicants located 
in rural, medically underserved areas. Applicants are advised to pay 
close attention to the specific program guidelines and general 
instructions in the application kit.

Application Requirements

    Each applicant for a cooperative agreement funded under this 
announcement must:
    1. Be a sustainable organization with an established network of 
partnering organizations capable of ensuring a coordinated women's 
health system in the community. The network of partnering organizations 
must have the capacity to plan and coordinate comprehensive health 
services (as defined below) for women and unite them with community-
based women's health research, teaching/training opportunities in 
community women's health, leadership opportunities for women in health, 
and community outreach/education activities in women's health.
    2. Demonstrate the ways in which the organization and the care that 
is coordinated through its partners are women-focused and sensitive to 
the importance of patient/provider communication/ relationships for 
medically underserved women of all ages. The care that is coordinated 
through this organization must be focused on health promotion, disease 
prevention, and treatment.
    3. Detail/specify the roles and resources that each partnership 
organization will bring to the project and state the duration and terms 
of agreement, as confirmed by a signed agreement between the applicant 
organization and each partner. The documents must be signed by 
individuals with the authority to represent the organization (e.g., 
president chief executive officer, executive director).
    Application Review Criteria: The technical review of applications 
will consider the following factors:
Factor 1: Background--10%
    Adequacy of demonstrated knowledge of systems of health care for 
underserved women at the local level; demonstrated need within the 
proposed community and target population of underserved women; 
demonstrated support and established linkages in order to conduct 
proposed National Community Center of Excellence in Women's Health 
model; extent and documented outcome of past efforts/activities with 
underserved women.
Factor 2: Objectives--10%
    Merit of the objectives outlined by the applicant to address the 
CCOE program goals (outlined above) in a way relevant to community 
needs and resources. Objectives should be measurable and attainable in 
the stated time frame.
Factor 3: Methodology--55%
    I. Extent to which the applicant demonstrates access to medically 
underserved women.
    II. Soundness of pre-existing community resources and linkages that 
can be built upon and coordinated to meet the requirements of the CCOE 
program.
    III. Appropriateness of proposed approach and specific activities 
described to address each element of the National Community Center of 
Excellence in Women's Health program including 1.comprehensive women's 
health services, 2. public outreach and education, 3. training for 
professional and lay health care workers working

[[Page 31556]]

with underserved women, 4. participatory community-based research, 5. 
leadership/career development for women providers, and women/girls in 
the community, and 6. ability to train others in lessons learned and 
replication of successful strategies.
    IV. Soundness of evaluation objectives for measuring program 
effectiveness and changes in health outcomes.
Factor 4: Management Plan--15%
    Applicant organization's capability to manage and evaluate the 
project as determined by: the qualifications of proposed staff or 
requirements for ``to be hired'' staff, proposed staff level of effort, 
management experience of the lead agency; and the experience of each 
partnership organization as it relates to its defined roles and to the 
National Center of Excellence in Women's Health model.
Factor 5: Evaluation--10%
    Thoroughness, feasibility and appropriateness of the evaluation 
design, and data collection and analysis procedures for the 
establishment of a National Community Center of Excellence in Women's 
Health. Potential for replication of the project for similar target 
populations and communities.
Award Criteria
    Funding decisions will be determined by the Director, Division for 
Program Management, Office on Women's Health, and will take under 
consideration: the recommendations and ratings of the review panel; 
funding preference; geographic distribution; and health problem areas 
having the greatest impact on women's health. Consideration will be 
given to projects proposed to be implemented in Empowerment Zones, 
Enterprise Communities; and preference to those in rural, medically 
underserved areas.

Definitions

    For the purposes of this cooperative agreement program, the 
following definitions are provided:
    Community-based: In which the locus of control and decision-making 
powers are located at the community level, representing the community 
or a significant segment of the community.
    Community-based Organization: Public and private, non-profit 
organizations which are representative of communities or significant 
segments of communities.
    Community health center: A community-based organization that 
provides comprehensive primary care and preventive services to 
medically underserved populations. This includes but is not limited to 
Federally Qualified health centers, Federally Qualified health center 
look-alike, Migrant Health Centers, Primary Care Public Housing Health 
Centers, Healthcare for the Homeless Centers, and other community-based 
health centers.
    Comprehensive women's health services: Services including, but 
going beyond traditional reproductive health services to address the 
health needs of underserved women in the context of their lives, 
including a recognition of the importance of relationships in women's 
lives, and the fact that women play the role of health providers and 
decision-makers for the family. Services include basic primary care 
services; acute, chronic, and preventive services; mental and dental 
health services; patient education and counseling; promotion of healthy 
behaviors (like nutrition, smoking cessation, substance abuse 
services); and enabling services. Ancillary services are also provided 
such as laboratory tests, X-ray, environmental, and pharmacy services.
    Coordinated care: The formal linkages, case management services, 
partnering arrangements, and patient advocate supports that rationalize 
women's health resources and help underserved women to navigate through 
the comprehensive health services they need. Community-based 
organizations are expected to coordinate with State and local health 
departments, nonprofit organizations, academic institutions, or other 
local organizations in the community as appropriate.
    Culturally competent: Information and services provided in the 
language, educational, and cultural context that is most appropriate 
for the individuals for whom the information and services are intended.
    Enabling services: Services that help women access health care, 
such as transportation, translation, child care, and case management.
    Healthy People 2010: A set of national health objectives that 
outlines the prevention agenda for the Nation. Healthy People 2010 
identifies the most significant preventable threats to health and 
establishes national goals for the next ten years. Individuals, groups, 
and organizations are encouraged to integrate Healthy People 2010 into 
current programs, special events, publications, and meetings. 
Businesses can use the framework, for example, to guide worksite health 
promotion activities as well as community-based initiatives. Schools, 
colleges, and civic and faith-based organizations can undertake 
activities to further the health of all members of their community. 
Health care providers can encourage their patients to pursue healthier 
lifestyles and to participate in community-based programs. By selecting 
from among the national objectives, individuals and organizations can 
build an agenda for community health improvement and can monitor 
results over time.
    Holistic: Looking at women's health from the perspective of the 
whole person and not as a group of different body parts. It includes 
mental as well as physical health.
    Integrated: In the CCOE context, the bringing together of the 
numerous spheres of activity that touch women's health, including 
clinical services, research, health training, public health outreach 
and education, and leadership development for women. The goal of this 
approach is to unite the strengths of each of these areas, and create a 
more informed and efficient system of women's health for underserved 
women.
    Multi-disciplinary: An approach that is based on the recognition 
that women's health crosses many disciplines, and that women's health 
issues need to be addressed across multiple disciplines, such as 
adolescent health, geriatrics, cardiology, mental health, reproductive 
health, nutrition, dermatology, endocrinology, immunology, 
rheumatology, etc.
    Participatory, community-based research: Research in which 
community members participate on equal footing, to maximize the 
potential for exchange in knowledge and implementation of research 
findings. Community members work with researchers to help determine 
research issues, shape the research process/ objectives, and bring 
research results back to the community. The shared goal is to maintain 
scientific rigor in the research methods, while also incorporating the 
skills, knowledge, and strengths of the participants/beneficiaries of 
the research. There is an emphasis on ensuring that research results 
are translated into practice and communicated back to the community.
    Sustainability: An organization's or program's staying power: the 
capacity to maintain both the financial resources and the partnerships/
linkages needed to provide the services demanded by the CCOE program. 
It also involves the ability to survive change, incorporate needed 
changes, and seize opportunities provided by a changing environment.
    Underserved Women: In the context of the CCOE model, women who 
encounter barriers to health care that result from any combination of 
the following characteristics: poverty,

[[Page 31557]]

ethnicity and culture, mental or physical state, housing status, 
geographic location, language, sexual orientation, age, and lack of 
health insurance.
    Women-centered: Addressing the needs and concerns of women in an 
environment that is welcoming to women, fosters a commitment to women, 
treats women with dignity, and empowers women through respect and 
education. The emphasis is on working with women not for women. Women 
clients are considered active partners in their own health and 
wellness.

Reporting and Other Requirements

General Reporting Requirements

    In addition to those listed above, a successful applicant will 
submit an annual progress report, an annual Financial Status Report, 
and a final Progress Report and a final Financial Status Report in the 
format established by the Office on Women's Health, in accordance with 
provisions of the general regulations which apply under ``Monitoring 
and Reporting Program Performance,'' 45 CFR part 74, Subpart J and Part 
92

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

    HHS 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 the Public Health Systems Reporting 
Requirements. Under these requirements, a community-based non-
governmental 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 on proposed 
health services grant applications submitted by community-based non-
governmental organizations within their jurisdictions.
    Community-based, non-governmental 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 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. Copies of the 
letters forwarding the PHSIS to these authorities must be contained in 
the application materials submitted to the Office on Women's 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 
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. The Office 
on Women's 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.)

    Authority: This program is authorized by 42 U.S.C. 300u-2(a)(1), 
300u-3, and 300u-6(e).

OMB Catalog of Federal Domestic Assistance

    The OMB Catalog of Federal Domestic Assistance Number is pending.

    Dated: May 11, 2000.
David Satcher,
Assistant Secretary for Health and Surgeon General.
[FR Doc. 00-12462 Filed 5-17-00; 8:45 am]
BILLING CODE 4160-17-U