[Federal Register Volume 66, Number 27 (Thursday, February 8, 2001)]
[Notices]
[Pages 9589-9591]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-3251]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Availability of Funds for Grants for the Community Access Program

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces the availability of up to $40 million to assist communities 
and their safety net providers in developing integrated health care 
delivery systems that serve the uninsured and underinsured with greater 
efficiency and improved quality of care. This funding is part of the 
$125 million appropriated for the Community Access Program (CAP) under 
the FY 2001 HHS Appropriations Act, of which $8.4 million is allocated 
for special projects and Agency-wide programmatic investments. For 
those applications that were approved, but not funded in FY 2000, 
approximately $56 million will be made available pending the results of 
their validation site visits. The remaining $20 million will be made 
available later in the fiscal year in the form of grants to new 
communities or in the form of supplemental/expansion awards to FY 2000 
grantees.
    In FY 2000, DHHS provided about $23 million in funding for 23 
communities for infrastructure development. In FY 2001, HRSA will 
provide grants to about 50 more communities which were approved but not 
funded in the FY 2000 application cycle. FY 2001 funding will also be 
used to support up to 40 additional communities to further their 
development of integrated delivery systems for the uninsured and 
underinsured. Grants will vary in size, based on the scope of the 
project and the size of the service area, and will be for one year.
    Through this program, HRSA will support infrastructure development 
in communities that have already begun to reorganize and integrate 
their health care delivery systems. Funding described in this notice is 
not intended to support those communities that have not yet begun the 
planning and development of necessary organizational structure.
    This program shares some of the same goals of the W.K. Kellogg 
Foundation's Community Voices Program and the Robert Wood Johnson 
Foundation's Communities in Charge Program. These foundations have also 
funded communities to develop integrated health care delivery systems 
for the uninsured, and CAP intends to build on the learning from their 
experiences.

DATES: The timeline for application submission, review, and award is as 
follows:
    January 26, 2001: Application kits and additional guidance will be 
available through the HRSA Grants Application Center (GAC).
    February 12-16, 2001: There will be a series of six pre-application 
workshops conducted across the country:

Nashville, TN--February 12, 2001
New Orleans, LA--February 12, 2001
Minneapolis, MN--February 14, 2001
Denver, CO--February 14, 2001
Philadelphia, PA--February 16, 2001
San Francisco, CA--February 16, 2001

    May 7, 2001: Applications due to HRSA Grants Application Center.
    June 11-22, 2001: Applications reviewed.
    July/August 2001: Site visits to selected applicants.
    September 2001: Grant awards announced.

ADDRESSES: To receive a complete application kit (i.e., application 
instructions, necessary forms, and application review criteria), 
contact the HRSA Grants Application Center at: HRSA GAC, 1815 N. Fort 
Myer Drive, Suite 300, Arlington, VA 22209, Phone: 1-877-HRSA-123, Fax: 
1-877-HRSA-345, E-Mail: [email protected].

FOR FURTHER INFORMATION CONTACT: For further information, contact the 
Community Access Program Office: Community Access Program Office, 
Health Resources and Services Administration, Parklawn Building, Suite 
11-25, 5600 Fishers Lane, Rockville, MD 20857, Phone: (301) 443-0536, 
Fax: (301) 443-0248.

SUPPLEMENTARY INFORMATION: In 1999, 42.6 million people in the United 
States did not have health insurance. Of these, 24.2 million were 
employed--19 million worked full time and 5.2 million worked part time.
    The uninsured and underinsured often have complex medical needs, 
remain outside organized systems of care, and have insufficient 
resources to obtain care. They may defer care or not receive needed 
services, and they are about half as likely to receive a routine check-
up as insured adults. The uninsured and underinsured also rely heavily 
on expensive emergency rooms, and because they lack a routine source of 
care, they often do not receive needed follow-up services.
    Many of the uninsured and underinsured rely on the nation's 
institutions, systems, and individual health professionals that provide 
a significant volume of health care services without regard for ability 
to pay. In many communities, these providers are struggling to care for 
the increasing numbers of uninsured and underinsured individuals. They 
face many challenges such as an uneven distribution of the burden of 
uncompensated care, the fragmentation of services for the uninsured, 
insufficient numbers of certain types of providers, reduced Medicaid 
revenues due to the market forces of Medicaid managed care, and a 
growing need for mental health and substance abuse services.
    While integration among these providers is critical to serve the 
uninsured and underinsured with greater efficiency and to improve 
quality of care, many of these providers are so pressured by basic 
caregiving tasks, they need assistance to coordinate their efforts with 
other providers and to develop integrated community-based systems of 
care.

The Community Access Program

    Program Purpose: The purpose of this program is to assist 
communities and consortia of health care providers to develop the 
infrastructure necessary to fully develop or strengthen integrated 
systems of care that coordinate health services for the uninsured and 
underinsured.
    Program Goal: The coordination of services through the CAP grant 
will allow the uninsured and underinsured to receive efficient and 
higher quality care and gain entry into a comprehensive system of care. 
The system will be characterized by effective collaboration, 
information sharing, and clinical and financial coordination among all 
levels of care in the community network. The system will be committed 
to continuous performance

[[Page 9590]]

improvement, implementation of best practices, staff development, and 
real-time feedback of outcomes of care. Care management (e.g., case, 
disease) will be applied across the continuum for those with chronic 
illnesses, high-risk individuals, and high utilizers. The system will 
also strive to provide universal access to the target population and to 
improve the health status of the community population.
    This vision requires a re-thinking of the relationships, 
priorities, and desired outcomes for local or regional care delivery. 
It means adopting the philosophy that care for the ill and injured 
occurs within the context of a comprehensive system design of 
population health improvement.
    The community being served should be actively involved in the 
system design. Broad understanding, mutual learning between providers 
and community, and participation in priority setting and governance by 
the community are essential components of this vision. This will assure 
sustainability of the system.

Program Description

    We are seeking to fund a variety of program models in communities 
that have an established track record for building partnerships and 
that have completed the basic planning necessary to implement a 
coordinated system of care. The successful applicant will design a 
project that builds upon its current capacities and strengths; brings 
the major players in the political and health delivery systems to the 
table; uses the federal funds available to plan a transition to an 
expanded and innovative approach that will ultimately be competitive 
within its own market; and will sustain the delivery of services and 
funding after these federal grants expire. The successful applicant 
will work with its county board, city council, state legislature, and 
state health programs to assure the coordination and efficient use of 
all available resources to achieve program goals.
    There is no one successful model that we are trying to replicate. 
Rather, there are many models that already exist and that each 
community may draw from in creating a project to address its own needs.
    In surveying innovative community approaches to the provision of 
safety net services, we have come across communities that have:
     Coordinated the provision of care through public 
hospitals, public health departments, and community health centers;
     Linked hospital and clinic services through state of the 
art data systems which allow transitions between Medicaid, uninsured, 
and insured status for low income populations;
     Combined the development of managed care networks for the 
indigent funded through local tax increases and the redirection of 
funds towards the care network and away from the support of tertiary 
care at public hospitals;
     Created networks to allocate uncompensated ambulatory care 
loads among physicians and redistribute caseloads to private providers; 
and
     Linked behavioral and acute care services.
    We are looking for applicants with clear goals, an operational plan 
for meeting those goals, a history of commitment to serving indigent 
populations, and a track record which indicates likely success. 
Innovative proposals for sustaining the service delivery component of 
projects could include use of local or state taxing authorities, use of 
tobacco settlement funds, and creative partnerships with the provider 
and business communities. Applications will be judged from the 
perspective of whether the financing proposed is realistic--given state 
and community resources--and appropriate to the project proposed. It is 
our intent to fund those applicants that either serve a target 
population that is distinct from the target population of other 
applicants or current CAP grantees, or propose distinct strategies that 
are coordinated and complimentary to those applicants or CAP grantees 
that have overlapping target populations.
    Funded projects will address several common elements:
    Community Need: Funded communities will have high or increasing 
rates of uninsured and underinsured and will have identified specific 
organizational needs within existing delivery systems. A ``community'' 
for the purpose of this program may be based on geography or a 
population group (e.g., the homeless) as defined by the people in the 
community.
    Collaboration Among Safety Net Providers: Funded communities will 
build upon current investments in communities for serving these 
populations and include the safety net providers who have traditionally 
provided services without regard to the ability to pay. The coalition 
should be built upon formal arrangements among the partners that define 
the extent of the commitment and involvement in policy development and 
decision-making from each partner.
    Comprehensive Services: Funded communities will include all 
partners necessary to assure access to a full range of services, 
including mental health and substance abuse treatment. It is 
anticipated that the health services (prevention, primary, and 
specialty) provided by Federally-supported programs that are present in 
the community will be part of this coalition of providers.
    Coordination with Public Insurance Programs: Funded communities 
will demonstrate coordination (e.g., memoranda of agreements) with 
state programs to ensure that eligible beneficiaries are enrolled in 
public insurance programs (e.g., SCHIP, Medicaid).
    Community Involvement: Funded communities will have strong 
community support for these efforts, which provide a broad foundation 
of assistance to the provider community undertaking this project. 
Management and governance structures should be in place that assure 
accountability to funders and define the community role in setting 
policy. The community involvement in the development, implementation, 
and governance of the project should be evident. This should include 
the leadership within the appropriate legislative and executive bodies, 
providers identified above, health plans and payers, community leaders 
and consumers.
    Sustainability: Funded communities will have a plan for long-term 
sustainability. There should be evidence that the program is capable of 
leveraging other sources of funds and integrating current funding 
sources in a way to assure long-term sustainability of the project.

Eligible Applicants

    To encourage the development of different models, this program 
seeks a variety of applicants representing all types of communities. 
Applicants which receive funding may be large health care systems or 
small organizations. Applications are encouraged from large urban 
areas, small rural communities, and tribal organizations.
    Applications may be submitted by public and private non-profit 
entities that demonstrate a commitment to and experience with providing 
a continuum of care to uninsured individuals. Each applicant must 
represent a community-wide coalition that is committed to the project 
and includes safety net providers (where they exist) who have 
traditionally provided care to the community's uninsured and 
underinsured regardless of ability to pay. The community-wide coalition

[[Page 9591]]

must consist of partners from all levels of care (i.e., primary, 
secondary, tertiary) and partners which represent a range of services 
(e.g., mental health and substance abuse treatment, maternal and child 
health, oral health, HIV/AIDS care).
    Examples of eligible applicants which may apply on behalf of the 
community-wide coalition include but are not limited to:

 A consortium or network of providers (e.g., public and 
charitable hospitals; community, migrant, homeless, public housing, and 
school-based health centers; rural health clinics; free health clinics; 
teaching hospitals and academic institutions)
 Local government agencies (e.g., local public health 
departments with service delivery components)
 Tribal governments
 Managed care plans or other payers (e.g., HMOs)
 Agencies of State government, multi-state health systems, or 
other groups may submit applications on behalf of multiple communities 
if they demonstrate the ability to coordinate community health care 
delivery systems and bring resources to the community.

    Current CAP grantees are not eligible to apply for this funding.

Funding Criteria

    Review criteria that will be used to evaluate applications include:

 Evidence of progress towards integration prior to application 
for funding
 Evidence that the target population has a high or increasing 
rate of uninsurance
 Evidence of established partnerships among a broad-based 
community consortium
 Appropriateness and quality of clinical services to be 
provided
 Commitments from local government agencies, public and private 
health care providers, community leaders
 Demonstration of existing and sustainable public and private 
funding sources
 Accountable management plan and reasonableness of the budget
 Commitment to self evaluation and participation in a national 
evaluation

Program Expectations

    Funding through this initiative may be used to support a variety of 
projects that would improve access to all levels of care for the 
uninsured and underinsured through coordinated systmes of care. Each 
community should design a project that best addresses the needs of the 
uninsured and underinsured, and the providers in their community.
    Examples of activities that could be supported with this funding 
include:

 Offering a comprehensive delivery system for the uninsured and 
underinsured through a network of safety net providers. [Single 
registration, eligibility systems]
 Integrating preventive, mental health, substance abuse, HIV/
AIDS, and maternal and child health services within the system. [Block 
grant funded services, other DHHS programs, state and local programs]
 Developing a shared information system among the community's 
safety net providers. [Tracking, case management, medical records, 
financial records]
 Developing and incorporating shared clinical protocols, 
quality improvement systems, utilization management systems, and error 
prevention systems.
 Sharing core management functions. [Finance, purchasing, 
appointment systems]
 Coordinating and strengthening priority services to specific 
targeted patient groups.
 Developing affordable pharmaceutical services.
    Applicants will be expected to budget for travel to two grantee 
meetings and to meet interim and final reporting requirements as 
directed by the Community Access Program.

Use of Grant Funds

    Funding provided through this program may NOT be used to substitute 
for or duplicate funds currently supporting similar activities. Grant 
funds may support costs such as:

 Project staff salaries
 Consultant support
 Management information systems (e.g., hardware and software)
 Project-related travel
 Other direct expenses necessary for the integration of 
administrative, clinical, information system, or financial functions
 Program evaluation activities

    With appropriate justification on why funds are needed to support 
the following costs, up to a total of 15 percent of grant funds may be 
used for the following:

 Alteration or renovation of facilities
 Development of additional primary care sites
 Service expansions or direct patient care

    Grant funds may NOT be used for:

 Construction
 Reserve requirements for state insurance licensure

Expected Results

    The integration and coordination of services among a community's 
safety net providers are expected to result in:

 A system of care that provides coordinated care to the target 
population.
 Increased access to primary care resulting in a reduction in 
hospital admissions for ambulatory sensitive conditions among the 
uninsured and underinsured.
 Elimination of unnecessary, duplicate functions in service 
delivery and administrative functions, resulting in savings to reinvest 
in the system.
 Increased numbers of low-income uninsured people with access 
to a full range of health services.

    Dated: January 31, 2001.
Claude Earl Fox,
Administrator.
[FR Doc. 01-3251 Filed 2-7-01; 8:45 am]
BILLING CODE 4160-15-U