[Federal Register Volume 66, Number 14 (Monday, January 22, 2001)]
[Notices]
[Pages 6611-6617]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-1807]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Office of Public Health and Science; Request for Applications for 
the National Community Centers of Excellence in Women's Health (CCOE) 
Program

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

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

    Purpose: To provide recognition and funding to community-based 
programs that unite promising approaches in women's health through the 
integration of the following six components: (1) Comprehensive health 
service delivery, (2) training for lay and professional health 
providers, (3) community-based research, (4) public education and 
outreach, (5) leadership development for women as health care consumers 
and providers, and (6) technical assistance to ensure 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 National Community Centers of 
Excellence in Women's Health (CCOE) program is not for the development 
of new programs or to fund direct service but rather to integrate, 
coordinate, and strengthen linkages between activities/programs that 
are already underway in the community in order to reduce fragmentation 
in women's health services and activities.
    The proposed CCOE program must address women's health from a women-
centered, women-friendly, women-relevant, holistic, multi-disciplinary, 
cultural and community-based perspective. Information and services 
provided must be at the educational level and within the language and 
cultural context that are most appropriate for the individuals for whom 
the information and services are intended. 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 be supported through the cooperative 
agreement mechanism, to allow a collaborative relationship between the 
CCOEs and the

[[Page 6612]]

Department of Health and Human Services (DHHS) offices. The DHHS 
funding offices include the Office on Women's Health (OWH), 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 offices will provide the technical assistance 
and oversight necessary for the implementation, conduct, and assessment 
of program activities.
    Specifically, the Federal Government will:
    1. Participate in at least two annual meetings with the CCOE Center 
Directors in the Washington, DC area.
    2. Participate in the development of a comprehensive national CCOE 
``how-to manual.''
    3. Review and approve the CCOEs'' local evaluations.
    4. Participate in a national evaluation of the CCOE programs using 
guidance/measurements provided by the OWH.
    5. Review and concur with project modifications.
    6. Review the design of CCOE home pages.
    7. Site visit CCOE facilities annually.
    8. Review all quarterly and final progress reports.
    The DHHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2010. Emphasis will be placed 
on aligning CCOE 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 Healthy People 2010 web site: http://www.health.gov/healthypeople. 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) 458-4636 [DHHS Publication No. (PHS) 99-1256]. This 
document may also be downloaded from the NCHS web site: http://www.cdc.gov/nchs.

Program Goals

    The goals of the CCOE program are to:
    1. Reduce the fragmentation of services and access barriers that 
women encounter using a framework that coordinates and integrates 
comprehensive health services with research, training, education, and 
leadership activities in the community to advance women's health.
    2. Create healthier communities with a more integrated and 
coordinated women's health delivery system targeted to underserved 
women.
    3. Empower underserved women as health care consumers and decision-
makers.
    4. Increase the women's health knowledge base using community-based 
research that involves the community in identifying research areas that 
address the health needs, and respond to, issues of concern to 
underserved women.
    5. Increase the number of health professionals trained to work with 
underserved communities and increase their leadership and advocacy 
skills.
    6. Increase the number of young women who pursue health careers and 
also increase the leadership skills and opportunities for women in the 
community.
    7. Spread the successes, through technical assistance, of model 
women's health program strategies and new innovations to communities 
across the country that may be interested in replicating the model.
    8. Eliminate 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 concept for the CCOE program is based on the National Centers 
of Excellence in Women's Health (CoE) program. The 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 (CCOE) program is to integrate, coordinate, and 
strengthen linkages between programs/activities that are already 
underway in the community to reduce fragmentation in women's health 
services and activities. Like the CoE program, the CCOE program must 
use an integrative approach that focuses on linking existing 
activities, rather than creating new ones, using the community-based 
organization as the nucleus for operationalizing the new model. The 
technical assistance component will enable the lessons learned from 
this unique model to be replicated in other communities around the 
country.
    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 community resources that address 
women's health activities and disciplines to increase awareness/
knowledge and to advance women's health efforts more efficiently.

Eligible Applicants

    The CCOE applicants must be a public or private nonprofit 
community-based hospital, community health center, or community-based 
organization serving underserved women. Community health centers funded 
under Section 330 of the Public Health Service Act are encouraged to 
apply. All applicants receiving Section 330 funding must identify 
themselves as recipients of these funds in the Background section of 
the application and by checking the appropriate response on the OWH 
Project Profile form. Community entities/organizations that have 
alliances, partnerships, networks with, or have other affiliations with 
an academic health center are also eligible to apply for a CCOE grant 
as long as the community entity/organization has a leading management 
role in the activity and maintains control of all funding. Academic 
health centers and state and county health departments are not eligible 
for funds under this announcement.
    To ensure a wide geographic distribution of the Center of 
Excellence in Women's Health model, applications will be accepted from 
organizations in all of the American States and Territories except 
those that already have a National Center of Excellence in Women's 
Health (CoE) program or a National Community Center of Excellence in 
Women's Health (CCOE) program. Thus, applications will not be accepted 
from programs in the following states: AZ, CA, IL, IN, LA, MA, MI, MO, 
NC, NY, PA, PR, WA, and WI. Preference will be given to DHHS regions 
that do not have a CCOE or a

[[Page 6613]]

CoE program and to programs proposed to be implemented in medically 
underserved areas, enterprise communities, and empowerment zones.

Deadline

    To be considered for review, applications must be received by May 
1, 2001. 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. Applications 
submitted by facsimile transmission (FAX) or any other electronic 
format will not be accepted. Applications that 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). Questions regarding programmatic information and/or requests for 
technical assistance in the preparation of grant applications should be 
directed in writing to Ms. Barbara James, CCOE Program Director, 
Division of Program Management, Office on Women's Health, Parklawn 
Building, Room 16A-55, 5600 Fishers Lane, Rockville, MD 20857, e-mail: 
[email protected].
    Technical assistance on budget and business aspects of the 
application may be obtained from Ms. Karen Campbell, Acting Grants 
Management Officer, Division of Management Operations, Office of 
Minority Health, Office of Public Health and Science, Rockville, MD 
20852, telephone: (301) 594-0758.
    Completed applications also should be submitted to: Ms. Karen 
Campbell, Acting Grants Management Officer, Division of Management 
Operations, Office of Minority Health, Office of Public Health and 
Science, Rockwall II Building, Room 1000, 5515 Security Lane, 
Rockville, MD 20852.

Availability of Funds

    The Office on Women's Health anticipates making between 3 to 5 new 
awards in FY 2001. Awards of up to $150,000 total costs (direct and 
indirect) for a 12-month period will be made to up to 5 competing 
applicants. However, the actual number of awards made will depend upon 
the amount of funds available for the CCOE program.

Period of Support

    The start date for the cooperative agreement will be September 30, 
2001. Support may be requested for a total project period not to exceed 
5 years. Noncompeting continuation awards of up to $150,000 (total 
cost) per year will be made subject to satisfactory performance and the 
availability of funds.

Use of Grant Funds

Project Requirements

    A CCOE program must: (1) Develop and/or strengthen a framework to 
bring together a comprehensive array of services for women; (2) develop 
promising strategies to train a cadre of health care providers capable 
of addressing issues at the community level that impact underserved 
women's health needs; (3) develop strategies to prevent and/or reduce 
illness or injuries that appear controllable through individual 
knowledge and behavior; (4) conduct community-based research in women's 
health; (5) enhance public education and outreach activities in women's 
health with an emphasis on prevention and/or reduction of illness or 
injuries that appear controllable through increased knowledge that 
leads to a modification of behavior; (6) promote leadership/career 
development for women in the health professions and women/girls in the 
community; (7) demonstrate an ability to foster the transfer of lessons 
learned to other communities interested in improvements in women's 
health; (8) evaluate their program; and (9) participate in a national 
evaluation of the CCOE program. A CCOE program 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. In addition, the 
CCOE program must contribute to the development of a comprehensive 
national CCOE ``how-to manual'' by submitting, as part of their annual 
report, a section on steps taken to implement each component of the 
CCOE program, a discussion of the effectiveness of the implementation 
strategy(ies) and how measured, and the impact of the program on the 
targeted community/population. A draft manual will be developed and 
made available to other organizations interested in establishing a CCOE 
program. The OWH plans to publish a final ``how-to manual'' near the 
end of the third cycle of funding for the CCOE program.
    At a minimum, each CCOE clinical care center must be a physically-
identifiable space, within the CCOE facility(s), for the delivery of 
comprehensive health care for women only. The CCOE clinical care center 
must have permanent signage and initially, at least 50 percent of the 
facility's space and 50 percent of the operational hours must be 
devoted to women-friendly, women-centered, women-relevant care 
delivered from a multidiscliplinary, holistic, and culturally and 
linguistically appropriate perspective. The CCOE clinical care center 
must also have a schedule and procedures for identifying and counting 
the women served by the CCOE and for tracking the cost of services 
provided to women who receive care through the CCOE program.

Use of Funds

    A majority of the funds from the CCOE award must be used to support 
staff and efforts aimed at coordinating and integrating the major 
components of the CCOE program. The Center Director, or the person 
responsible for the day-to-day management of the CCOE program, must 
devote at least a 50 percent level of effort to the program. 
Additionally, 25 percent of the funds must target efforts to foster the 
transfer of lessons learned/successful strategies from the CCOE program 
(technical assistance). These may include either process-based lessons 
(i.e., How to bring multiple community partners together) or outcomes-
based lessons (i.e., 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; participating in the 
development of national replication guides/materials; and providing 
technical assistance to health professionals, directly or through their 
professional organizations, interested in working with underserved 
women in the community. Applicants must provide a plan for how they 
will provide technical assistance in the first year. They will be 
expected to identify at least one sustained interaction with another 
community, beginning no later than 6 months after receipt of the CCOE 
award, and provide materials for the development of a manual that 
describes how to link, coordinate, and partner within the community to 
form the CCOE infrastructure.

[[Page 6614]]

    Funds may be used for personnel, consultants, supplies (including 
screening, education, and outreach supplies), and grant related travel. 
Items costing less than $5,000 are considered to be supplies. Funds may 
not be used for construction, building alterations, equipment, medical 
treatment, or renovations. All budget requests must be justified fully 
in terms of the proposed CCOE goals and objectives and include a 
computational explanation of how costs were determined.
    The CCOE Center Directors will meet twice a year in the Washington 
metropolitan area. The CCOE's budget should include a request for funds 
to pay for the travel, lodging, and meals for the first Center 
Directors' meeting of each year. The first meeting is usually held 
between mid-October and mid-December. The OWH will pay the travel and 
other expenses associated with the second annual CCOE meeting.

Criteria for Evaluating Applications

Review of Applications

    Applications will be screened upon receipt. Those that are judged 
to be incomplete, arrive after the deadline, or from states that 
already have a CCOE or a CoE program will be returned without review or 
comment. Accepted applications will be reviewed for technical merit in 
accordance with DHHS policies. Applications will be evaluated by a 
technical review panel composed of experts in the fields of program 
management, community service delivery, community outreach, health 
education, community-based research, and community leadership 
development. Consideration for award will be given to applicants that 
best demonstrate progress and/or plausible strategies for eliminating 
health disparities through the integration of services, community-based 
research, education, training, leadership/career development, and 
technical assistance to other communities. Applicants are advised to 
pay close attention to the specific program guidelines and general 
instructions in the application kit and to the definitions provided.

Application Requirements

    Each applicant for a cooperative agreement grant funded under this 
CCOE announcement must, at a minimum:
    1. Present a plan to integrate all six components of the CCOE 
program by the end of the first year of funding, although only four 
components have to be in place at the time the application is 
submitted. The challenge of the CCOE model is to stretch the ``medical 
health care model'' and ``think out of the box'' about ways to improve 
the health status of underserved women. Applicant are encouraged to be 
creative in suggesting ways to increase integration among the CCOE 
components.
    2. Develop a CCOE advisory board or ensure that their already 
established advisory board is included in the decision-making process 
for CCOE program development, identification of community-based 
research questions, and formulation of CCOE policies. Applicants should 
also ensure that the advisory board includes representative(s) from 
their community partners.
    3. Be a sustainable organization with an established network of 
partners capable of providing coordinated and integrated women's health 
services in the targeted community. The network of partner 
organizations must have the capability to coordinate and provide 
comprehensive, seamless health services for women and empower them with 
community-based women's health research information that addresses 
issues of particular concern to the women, teaching/training 
opportunities in women's health, leadership opportunities for community 
women in health, and community outreach/education activities in women's 
health to improve the health status of women in the community. The 
applicant will need to define the components of comprehensive care, 
demonstrate that they are culturally, linguistically, and gender 
appropriate, and show that they have a clear and sustainable framework 
for providing those services.
    4. Have an established clinical care center/facility, an operating 
public educational/outreach program, and a community identified as the 
recipient of technical assistance at the time the application is 
submitted. A time line and plans for phasing in the remaining CCOE 
components by the end of Year 1 must be described in detail in the 
application.
    5. Demonstrate the ways in which the organization and the care that 
are coordinated through its partners are women-focused, women-friendly, 
women-relevant, 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.
    6. Detail/specify the roles and resources/services that each 
partner organization brings to the program, the duration and terms of 
agreement as confirmed by a signed agreement between the applicant 
organization and each partner, and describe how the partner 
organizations will operate within the CCOE structure. The partnership 
agreement(s) must name the individual who will work with the CCOE 
program, describe their function, and state their qualifications. The 
documents, specific to each organization (form letters are not 
acceptable), must be signed by individuals with the authority to 
represent the organization (e.g., president, chief executive officer, 
executive director) and submitted as part of the grant application.
    7. Describe in detail plans for the local evaluation of the CCOE 
program and when and how information obtained from the evaluation will 
be used to enhance the CCOE program. The applicant most also indicate 
their willingness to participate in a national evaluation of the CCOE 
program to be conducted under the leadership of the OWH.
    8. Describe in detail the planned community-based research and the 
research methodology/procedure. Applicants may: (a) Propose original 
patient-oriented research; (b) enter into a formal agreement with 
institutions conducting population-based research to facilitate women's 
entry into clinical trial(s)/patient-oriented research; (c) participate 
in the national evaluation of the CCOE program (required of all 
awardees); (d) link with organizations conducting community-based 
research; and/or (e) propose other creative research projects. To 
satisfy the community-based research component of the CCOE program, all 
applicants must undertake at least two of the research activities 
listed above, in addition to the required participation in the national 
CCOE evaluation.

Application Review Criteria

    The technical review of applications will consider the following 
factors:

Factor 1: Implementation Plan--45%

    This section must discuss:
    1. Appropriateness of the existing community resources and linkages 
established to deliver coordinated women's services to meet the 
requirements of the CCOE program.
    2. Appropriateness of proposed approach, component integration, and 
specific activities described to address each element of the National 
Community Center of Excellence in Women's Health program including: (a) 
Comprehensive women's health services, (b) outreach and education, (c) 
training for professional and lay health

[[Page 6615]]

care workers serving underserved women, (d) community-based research 
that involves the community in substantive roles/ways, (e) leadership/
career development for women providers, and women/girls in the 
community across the life span, and (f) technical assistance-the 
ability to train others in lessons learned and replication of 
successful strategies. Although all components of the CCOE do not have 
to be in place/operational at the time the application is submitted, 
the applicant must discuss/describe the resources available to support 
each component, time lines and plans for phasing in each component, and 
the relationship of each component to the overall goals and objectives 
of the CCOE program.
    3. Soundness of evaluation objectives for measuring program 
effectiveness and changes in health outcomes.
    4. Willingness to participate in the national CCOE evaluation.
    5. Willingness to contribute to the development of a comprehensive 
national CCOE ``how-to manual.''

Factor 2: Management Plan--15%

    Applicant organization's capability to manage the project as 
determined by the qualifications of the proposed staff or requirements 
for ``to be hired'' staff, proposed staff level of effort, management 
experience of the lead agency and the experience, resources and role of 
each partner organization as it relates to the needs and programs/
activities of the CCOE program, diversity of the CCOE staff as it 
relates to and reflects the community and populations served, and 
integration of the advisory board into the CCOE activities.

Factor 3: Evaluation Plan--10%

    A clear statement of program goal(s) and thoroughness, feasibility 
and appropriateness of the local CCOE evaluation design, data 
collection plan, analysis of results, and procedures to determine if 
program goals are met. A clear statement of willingness to be involved 
actively in the national CCOE evaluation.

Factor 4: Technical Assistance--10%

    Plans for the provision of technical assistance and the potential 
for replication of the CCOE model in similar populations and 
communities. The plan must include justification for the community 
selected and a detailed discussion of how the applicant will sustain 
interaction with the community. Technical assistance to the selected 
community must begin no later than 6 months after receipt of the CCOE 
award.

Factor 5: Objectives--10%

    Merit of the objectives outlined by the applicant to address the 
CCOE program discussed in the program goals section in a way relevant 
to the targeted community needs and available resources. Objectives 
must be measurable and attainable within a stated time frame.

Factor 6: Background--10%

    Adequacy of demonstrated knowledge of systems of health care for 
underserved women at the local level; demonstrated need within the 
proposed local community and target population of underserved women; 
demonstrated support and established linkages in place to operate a 
fully functional CCOE program; demonstrated access to medically 
underserved women; and documented past efforts/activities outcome with 
underserved women.

Award Criteria

    Funding decisions will be made by the Office on Women's Health, and 
will take into consideration the recommendations and ratings of the 
review panel, program needs, geographic location, stated preferences, 
and the recommendations of DHHS Regional staff. A pre-site visit, 
conducted by DHHS regional staff, will be scheduled prior to the award 
of a grant with all applicants with scores in the funding range. The 
purpose of the visit will be to assess the applicants readiness to 
implement a CCOE program.

Organization of Application

    Applicants are required to submit an original ink-signed and dated 
application and 15 photocopies. All pages must be numbered clearly and 
sequentially beginning with the Project Profile. The application must 
be typed double-spaced on one side of plain 8\1/2\"  x  11" white 
paper, using at least a 12 point font, and contain 1" margins all 
around.
    The Project Summary and Project Narrative must not exceed a total 
of 25 double-spaced pages, excluding the appendices. The original and 
each copy must be stapled and/or otherwise securely bound. The 
application should be organized in accordance with the format presented 
in the Program Guidelines. An outline for the minimum information to be 
included in the ``Project Narrative'' section is presented below.

I. Background
    A. Local CCOE purpose(s) and goals
    B. Section 330 funding
    C. Local CCOE program objectives
    1. Tied to program goal(s)
    2. Measurable with time frame
    3. Elements identified in Factor 5: Objectives
    D. CCOE organization charts that include partners and a 
discussion of the resource being contributed to the CCOE, partners, 
personnel and their expertise and how their involvement will help 
achieve the CCOE program goals
II. Implementation Plan (Approach to the establishment of the CCOE 
program)
    1. Components in place and plans with a timetable for phasing in 
the other CCOE components
    2. Partnerships and referral system/follow up
    3. Community-based research
    4. National CCOE ``how-to manual''
    5. Elements identified in Factor 1: Implementation Plan
III. Management Plan
    A. Key project staff
    B. To-be-hired staff and their qualifications
    C. Staff responsibilities
    D. Management experience of the lead agency and partners as 
related to their role in the CCOE program
    E. Advisory board
    F. Elements identified in Factor 2: Management Plan
IV. Local CCOE Evaluation Plan
    A. Purpose
    B. Design/methodology
    C. Use of results to enhance programs
    D. Elements identified in Factor 3: Evaluation Plan
V. Technical Assistance/Replication Strategy
    A. Identification of Technical Assistance community
    B. Reason for selection of Technical Assistance community
    C. Technical Assistance plans/strategies/time line
    D. Plans for sustaining Technical Assistance
    E. Elements identified in Factor 4: Technical Assistance
Appendices
    A. Progress Report Outline
    B. Memorandums of Agreement/Understanding/Partnership Letters
    C. Required Forms (Assurance of Compliance Form, etc.)
    D. Other Attachments

Definitions

    For the purposes of this cooperative agreement program, the 
following definitions are provided:
    Clinical Care Center: At a minimum, each CCOE clinical care center 
must be a physically-identifiable space, within the CCOE facility(s), 
for the delivery of comprehensive health care for women only. The CCOE 
clinical care center must have permanent signage and initially, at 
least 50 percent of the facility's space and 50 percent of the 
operational hours must be devoted to women-friendly, women-centered, 
women-relevant care delivered from a multidisciplinary, holistic, and 
culturally and linguistically appropriate perspective. The CCOE 
clinical care

[[Page 6616]]

center must also have a schedule and procedures for identifying and 
counting the women served by the CCOE and for tracking the cost of 
services provided to women who receive care through the CCOE program.
    Community-based: The locus of control and decision-making powers 
are located at the community level, representing the service area of 
the community or a significant segment of the community.
    Community-based organization: Public and private, nonprofit 
organizations that are representative of communities or significant 
segments of communities.
    Community-based research: Community members work with researchers 
to help determine research issues, shape the research process/
objectives, and bring research results back to the community. Community 
members' participation maximizes the potential for exchange in 
knowledge and implementation of research findings. The shared goal is 
to maintain scientific integrity 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.
    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 
programs reimbursed through the Federally Qualified Health Centers 
mechanism, 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 physical activity); and enabling services. Ancillary services are 
also provided such as laboratory tests, X-ray, environmental, social 
referral, and pharmacy services.
    Coordinated care: The formal linkages, case management services, 
partnering arrangements, and patient advocate support that enable 
better coordination of women's health resources and help underserved 
women to navigate systems to obtain 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 at the 
educational level and in the language and cultural context that are 
most appropriate for the individuals for whom the information and 
services are intended.
    Cultural perspective: Recognizes that culture, language, and 
country of origin have an important and significant impact on the 
health perceptions and health behaviors that produce a variety of 
health outcomes.
    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 (6 CCOE components) that touch women's 
health, including clinical services, research, health training, public 
health outreach and education, leadership development for women, and 
technical assistance. The goal of this approach is to unite the 
strengths of each of these areas, and create a more informed, less 
fragmented, and efficient system of women's health for underserved 
women that can be replicated in other populations and communities.
    Lifespan: Recognizes that women have different health and psycho-
social needs as they encounter transitions across their lives and that 
the positive and negative effects of health and health behaviors are 
cumulative across a woman's life.
    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, dental health, etc.
    Social Role: Recognizes that women routinely perform multiple, 
overlapping social roles that require continuous multi-tasking.
    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, ethnicity and culture, mental 
or physical state, housing status, geographic location, language, 
sexual orientation, age, and lack of health insurance/under-insured.
    Women-centered/women-focused: Addressing the needs and concerns of 
women (women-relevant) 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 that includes a summary of the local 
CCOE evaluation and a discussion of steps taken to

[[Page 6617]]

implement each component of the CCOE program and the impact of the 
program on the targeted community/population, an annual Financial 
Status Report, a final Progress Report, a final Financial Status 
Report, and a technical assistance documentation 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.
    Additionally, a successful applicant will submit quarterly progress 
reports. An original and two copies of the quarterly progress report 
must be submitted by January 1, April 1, July 1, and October 1. The 
last quarterly report will serve as the annual progress report and will 
describe all project activities for the entire year. The annual 
progress report is submitted by October 1 of each year, with the 
exception of the last year of the award when the report will be due by 
September 30.

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

    DHHS strongly encourages all grant recipients to provide a smoke-
free workplace and to 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.

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 apprized 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, and (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 in 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.)

OMB Catalog of Federal Domestic Assistance

    The OMB Catalog of Federal Domestic Assistance Number is 93.290.

    Dated: January 16, 2001.
David Satcher,
Assistant Secretary for Health and Surgeon General.
[FR Doc. 01-1807 Filed 1-19-01; 8:45 am]
BILLING CODE 4160-17-U