[Federal Register Volume 66, Number 99 (Tuesday, May 22, 2001)]
[Notices]
[Pages 28183-28187]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-12882]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-2125-N]


Medicaid Program; Infrastructure Grant Program To Support the 
Design and Delivery of Long Term Services and Supports That Permit 
People of Any Age Who Have a Disability or Long-Term Illness To Live in 
the Community

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice of funding availability.

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SUMMARY: This notice announces the availability of approximately $70 
million in grant funding through ``Systems Change Grants for Community 
Living''. The ``Systems Change'' grants include four distinct 
competitive grant opportunities: (1) ``Nursing Facility Transitions''; 
(2) ``Community-Integrated Personal Assistance Services and Supports''; 
(3) ``Real Choice Systems Change''; and (4) ``National Technical 
Assistance Exchange for Community Living''. The four grants are 
designed to assist States to develop enduring infrastructures that 
support people of any age who have a disability or long-term illness to 
live and participate in their communities. Applicants include States, 
State instrumentalities, and other eligible entities as further 
described in the notice. This notice also contains information about 
the application process.

DATES: Deadline for Letter of Intent To Apply: Applicants should submit 
a letter of intent to apply for a grant no later than June 8, 2001. 
Although it is not mandatory for an applicant to submit a letter of 
intent, we would appreciate receiving a letter of intent from each 
applicant because it will help us to plan our review panels.
    Deadlines for Submission of Grant Applications: To be considered 
under the Fiscal Year 2001 funding cycle, grant applications must be 
submitted by the deadlines listed below:

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------------------------------------------------------------------------
                    Grants                       Application  deadline
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 Nursing Facility Transitions........  July 20, 2001.
     Independent Living Partnerships.
     State Program Grants............
 Community-integrated Personal         July 20, 2001.
 Assistance Services and Supports.
 Real Choice Systems Change..........  July 20, 2001.
 National Technical Assistance         July 16, 2001.
 Exchange for Community Living.
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ADDRESSES: Letter of Intent to Apply: The letter of intent to apply is 
included in the solicitation as Appendix Seven ``Letter of Intent to 
Apply''; the solicitation may be found on the HCFA web site at: http://www.hcfa.gov/medicaid/systemschange. All letters of intent to apply 
must be submitted to: Jeremy Silanskis, Health Care Financing 
Administration, Center for Medicaid and State Operations, DEHPG/DASI, 
Mail Stop: S2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850. 
Letters of intent to apply may be submitted by facsimile to Jeremy 
Silanskis at (410) 786-9004. For those unable to access the HCFA web 
site containing the full solicitation (including Appendices), copies of 
the solicitation are available through Susan Hill. (See For Further 
Information Contact.)
    Application Materials: Standard application forms and related 
instructions are available through either: (1) Judith Norris, Health 
Care Financing Administration, Office of Internal Customer Support, 
AGG, Grants Management Staff, Mail Stop: C2-21-15, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850, (410) 786-5130, 
Internet:[email protected], or (2) the HCFA web site at: http://www.hcfa.gov/ord/grantop.htm.
    Submission of Application: Applicants are required to submit (1) an 
original and two copies of the application and (2) a 3\1/4\" floppy 
disk containing at least the narrative and the budget. Although it is 
not mandatory and does not impact on the scoring of an application, we 
would appreciate receiving an original and 14 copies of the 
application. For further information regarding the provisions of the 
grants, application format and requirements, review criteria and 
procedures, explanation of timely submission, and other relevant 
information, applicants must refer to the grant solicitation available 
on the HCFA web site at: http://www.hcfa.gov/medicaid/systemschange.
    All application forms and related materials must be submitted to: 
Judith Norris, Health Care Financing Administration, Office of Internal 
Customer Support, AGG, Grants Management Staff, Mail Stop: C2-21-15, 
7500 Security Boulevard, Baltimore, Maryland 21244-1850, (410) 786-
5130, Internet:[email protected].
    Each type of grant has a specific closing date. (See DATES section 
above.) Applications mailed through the U.S. Postal Service or a 
commercial delivery service will be considered ``on time'' if received 
by close of business on the closing date, or postmarked (first class 
mail) by the date specified and received within five business days. If 
express, certified, or registered mail is used, the applicant should 
obtain a legible dated mailing receipt from the U.S. Postal Service. 
Private metered postmarks are not acceptable as proof of timely 
mailings. Applications that do not meet the above criteria will be 
considered late applications. Applicants who submit late applications 
will be notified that their applications were not considered in the 
competition. Late applications will not be reviewed and will be 
returned to the applicant.
    Web Site: To obtain up-to-date information about the ``Systems 
Change'' grants and a complete grant solicitation, please check our web 
site at: http://www.hcfa.gov/medicaid/systemschange. For those unable 
to access the HCFA web site containing the full solicitation (including 
Appendices), copies of the solicitation are available through Susan 
Hill. (See For Further Information Contact.)

FOR FURTHER INFORMATION CONTACT: Questions about the grant program may 
be directed to: Susan Hill, Health Care Financing Administration, 
Center for Medicaid and State Operations, DEHPG/DASI, Mail Stop: S2-14-
26, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-2754, 
Internet:[email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    People of all ages who have a disability or long-term illness 
generally express the same desire to live in the community as do most 
other Americans. They express a desire to live in their own homes, make 
their own decisions about daily activities, work, learn, and maintain 
important social relationships. They express a desire to contribute and 
participate in their communities and family life.
    In 1990, the Congress enacted the Americans with Disabilities Act 
(ADA) (Pub. L. 101-336). The ADA recognized that ``society has tended 
to isolate and segregate individuals with disabilities, and, despite 
some improvements, such forms of discrimination against individuals 
with disabilities continue to be a serious and pervasive social 
problem'' (42 U.S.C. section 12101(a)(2)). The ADA gave legal 
expression to the desires and rights of Americans to lead lives as 
valued members of their own communities despite the presence of 
disability.
    Over the past few years, a consensus for assertive new steps to 
improve the capacity of our long-term support systems to respond to the 
desires of our citizenry has been building. Federal, State, and local 
governments have begun to take actions to renew and reaffirm a 
commitment to improving the systems that will support people of all 
ages with disabilities or long-term illnesses who wish to live in their 
communities.
    Several Federal and State initiatives are underway to make 
community living a reality for more people. We adopted a number of 
Medicaid policy reforms and issued grants to facilitate State efforts 
to improve their community services systems. Numerous States have 
implemented home and community-based waivers through the Medicaid 
program. As States learn more from these experiences, waivers will 
continue to evolve. States are interested in building in more consumer 
choice and consumer-directed services. In addition, the Substance Abuse 
and Mental Health Services Administration (SAMHSA) announced planning 
grants to assist States in their planning efforts. The U.S. Department 
of Housing and Urban Development (HUD) entered into a memorandum of 
understanding with HHS to coordinate community housing subsidies with 
human service funds in a manner that will make transition from nursing 
facilities to the community more feasible. The Administration on Aging 
(AoA) inaugurated a nationwide caregiver support program.

[[Page 28185]]

    The Congress also recognized that States face formidable challenges 
in their efforts to fulfill their legal responsibilities under the ADA. 
The Congress appropriated funds for these ``Systems Change'' grants 
specifically to improve community-integrated services.
    In February 2001, President George W. Bush announced a broad ``New 
Freedom Initiative'' to ``tear down barriers to equality'' and grant a 
``New Freedom'' to children and adults of all ages who have a 
disability or long term illness so that they may live and prosper in 
their communities. For more information on the President's ``New 
Freedom Initiative'', please visit the web site at: http://www.whitehouse.gov.
    The ``Systems Change Grants for Community Living'' described in 
this document represent an expression of support for States' efforts to 
provide additional or improved support for community living. In 
addition, these grants support: the President's ``New Freedom 
Initiative''; the States'' efforts to fulfill the ADA; and the long-
standing desire of people of all ages who have a disability or long-
term illness to live and participate in their communities with dignity 
and value.

II. Overview and General Requirements for All ``Systems Change'' 
Grants

    Attached is a chart summarizing the Systems Change Grants. The 
following four distinct competitive grant solicitations comprise the 
``Systems Change'' grants:
     ``Nursing Facility Transitions (TRANSITIONS)'' grants: The 
purpose of the ``TRANSITIONS'' grants is to help eligible individuals 
make the transition from nursing facilities to the community. Between 
$10 to $14 million in two types of grants are available from HCFA: 
State Program grants and Independent Living Partnership grants. State 
Program grants can be used for a wide range of activities, for example, 
a State may wish to use State Program grant funds to develop strategies 
for linking individuals with disabilities to Section 8 rental housing 
vouchers or developing other coordinated housing strategies. The 
Independent Living Partnership grants are designed to promote 
partnerships between States and selected Independent Living Centers 
(ILCs) \1\ to support the transition of individuals from nursing 
facilities to their communities.
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    \1\ Independent Living Centers (ILCs) refer to those ILCs 
recognized under State or Federal Law.
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     ``Community-Integrated Personal Assistance Services and 
Supports (Community PASS)'' grants: Personal assistance is the most 
frequently used service that enables people with a disability or long-
term illness to live in the community. Many States have taken a 
leadership role in designing systems that not only offer the basic 
personal assistance service, but also make that service available in a 
manner that affords consumers maximum control over the selection of 
individuals working on their behalf and the manner in which services 
are provided. These grant funds will be used by States to improve 
personal assistance services that are consumer-directed or offer 
maximum individual control. Grants totaling $5 to $8 million are 
available to support States' efforts to improve community-integrated 
personal assistance services for children and adults of any age who 
have a disability or long-term illness.
     ``Real Choice Systems Change (Real Choice)'' grants: The 
goal of these grants is to help design and implement effective and 
enduring improvements in community long-term support systems to enable 
children and adults of any age who have a disability or long-term 
illness to live and participate in their communities. Direct grants 
totaling $41 to $43 million are available to assist States and their 
disability and aging communities to work together to find viable ways 
to expand or improve the design and delivery of community-integrated 
services. The funds will also support the public-private partnerships 
and broad public participation (including a consumer task force) that 
are generally needed to accomplish such an ambitious undertaking.
     ``National Technical Assistance Exchange for Community 
Living (The Exchange)'' grant: This national technical assistance grant 
will support the ``Real Choice Systems Change'' grants, the ``Nursing 
Facility Transitions,'' and the ``Community-Integrated Personal 
Assistance Services and Supports'' efforts. The purpose of this 
national technical assistance initiative will be to provide technical 
assistance, training, and information to States, Grantees, consumers, 
families, and other agencies and organizations. Funding for technical 
assistance will range from $4 to $5 million.

A. Timing and Duration of Awards

    We expect all grant awards to be made before to October 1, 2001. 
Grantees may expend grant funds over a 36-month period from the date of 
the award.

B. Match Requirements

    Grantees of the Nursing Facility Transitions, Community PASS, and 
``Real Choice'' grants are required to make a nonfinancial recipient 
contribution of 5 percent of the total grant award. Nonfinancial 
recipient contributions may include the value of goods and/or services 
contributed by the Grantee, for example, salary and fringe benefits of 
staff devoting a percentage of their time to the grant not otherwise 
included in the budget or derived from Federal funds. Recipient 
contributions must be included in the Applicant's Budget on Standard 
Form 424A. The nonfinancial match requirement may also be satisfied if 
a third party participating in the grant makes an ``in-kind 
contribution,'' provided that the Grantee's contribution and/or the 
third-party in-kind contribution equals 5 percent of the total grant 
award. Third-party ``in-kind contributions'' may include the value of 
the time spent by consumer task force members (using appropriate cost 
allocation methods to the extent that non-Federal funds are involved) 
who specifically contribute to the design, development, and 
implementation of the grant.
    Grantees applying for the National Technical Assistance Exchange 
for Community Living grant will be required to make a nonfinancial 
recipient contribution of 1 percent of the total grant award. 
Applicants must specify these required recipient contributions in their 
Budget on Standard Form 424A.

C. Indirect Costs

    Reimbursement of indirect costs under each of the four grant 
solicitations is governed by the provisions of the U.S. Department of 
Health and Human Services, Grants Policy Directive (GPD) Part 3.01: 
Post-Award--Indirect Costs and Other Cost Policies. We recommend that 
applicants review the provisions of this policy directive and 
applicable Office of Management and Budget (OMB) circulars in preparing 
budget information. This information is available in the solicitation 
and online at: http://www.hhs.gov/grantsnet/adminis/gpd/gpd301.htm.

D. Who May Apply

    States may apply for any grant, except the Independent Living 
Partnership portion of the ``TRANSITIONS'' grant. By ``State'' we refer 
to the definition provided under 45 CFR 74.2 as ``any of the several 
States of the United States, the District of Columbia, the Commonwealth 
of Puerto Rico, any territory or possession of the United States, or 
any agency or instrumentality of a State exclusive of local 
governments.'' By ``territory or possession'' we mean Guam, the U.S. 
Virgin Islands, American Samoa, and

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the Commonwealth of the Northern Mariana Islands.
    For the ``Real Choice Systems Change'' grants and the State Program 
portion of the ``Nursing Facility Transitions'' grant, only State 
agencies or instrumentalities may apply. These agencies must have the 
support and active participation of one of the following: the Governor, 
the State Medicaid agency, or the State agency administering a relevant 
section of the 1915(c) home and community-based waiver.
    For the Independent Living Partnership portion of the ``Nursing 
Facility Transitions'' grant, only Independent Living Centers may 
apply. Each Applicant must have (1) the support and active 
participation from the State Medicaid agency or the State agency 
administering a relevant section of the 1915(c) home and community-
based waiver, and (2) the support and active participation of at least 
two other consumer-governed organizations.
    For the ``Community PASS'' grants, any State agency or any other 
organization may apply if it has the support and active participation 
of one of the following: the Governor, the State Medicaid agency, or 
the State agency administering a relevant section of the 1915(c) home 
and community-based waiver.
    For the ``National Technical Assistance Exchange for Community 
Living'' grant, any organization may apply. However, according to 45 
CFR 74.81, no funds may be paid as profit to any recipient 
organization.
    States may and are encouraged to apply for more than one type of 
grant. For example, a State may apply for a ``Real Choice Systems 
Change'' grant and also apply for a ``Nursing Facility Transitions'' 
grant. Also, different State agencies may apply for different types of 
grants. For example, the Medicaid agency might apply for a ``Community 
PASS'' grant, and the agency administering the section 1915(c) waiver 
might apply for a ``Nursing Facility Transitions'' grant. However, no 
State may be awarded more than one grant per State per type of grant. 
For example, a State may not receive two ``Real Choice Systems Change'' 
grants or two ``Community PASS'' grants. Neither an Independent Living 
Partnership grant nor a technical assistance grant will count against 
this limit.
    In addition, a State, or other eligible entity, may submit a single 
application for any one type of grant that is composed of multiple, 
interrelated projects. For example, a State might submit an application 
for the ``Real Choice Systems Change'' grant that is composed of a 
``one-stop shopping'' demonstration and a separate but related project 
to solve the shortage of front-line workers. While only one entity may 
receive the grant, the Grantee agency may subcontract portions of the 
award consistent with the Applicant's proposed project. A potential 
Applicant may request written clarification from us in advance of the 
application due date if it is unclear whether it is eligible to apply 
for a particular grant.
    HCFA reserves the right to assure reasonable balance in the 
awarding of grants, in terms of key factors such as geographic 
distribution, broad target group representation, etc.

E. Involvement of Consumers, Stakeholders, and Public-Private 
Partnerships

    For all grant solicitations, we strongly encourage the continuous, 
active involvement of consumers in both project design and 
implementation. We encourage processes that promote the active 
involvement of all other stakeholders. In addition, we encourage the 
development of public-private partnerships that make the most effective 
use of each partner's expertise.
    For the ``Real Choice Systems Change'' grants, the Congress 
expressed its preference that the grant applications ``be developed 
jointly by the State and the Consumer Task Force. The Task Force should 
be composed of individuals with disabilities from diverse backgrounds, 
representatives from organizations that provide services to individuals 
with disabilities, consumers of long-term services and supports, and 
those who advocate on behalf of such individuals'' (H. Conf. Rep. No. 
106-1033 at 150).
    We encourage collaboration with a broad range of public and private 
organizations whose primary purpose is advocating for people with 
disabilities or long-term illnesses. Examples of these organizations 
include State Independent Living Councils, Area Agencies on Aging 
(AAAs), Developmental Disabilities Councils, State Mental Health 
Planning Councils, State Assistive Technology Act Projects (AT Act 
Projects), and other national and statewide consumer disability and 
aging organizations. We also encourage Applicants to partner with 
volunteer groups, employers, faith-based service providers, private 
philanthropic organizations, and other community-based organizations.
    For more information regarding the options available to States 
relative to the consumer task force and other more detailed questions 
related to these grants, please visit our web site at http://www.hcfa.gov/medicaid.

F. Executive Order 12372

    Applications for these grants are not subject to review by States 
under Executive Order 12372, ``Intergovernmental Review of Federal 
Programs'' (45 CFR Part 100).

G. Information Collection Requirements

    The information collection requirements associated with the 
solicitation are under review by the Office of Management and Budget. 
We published a notice in the Federal Register on May 10, 2001, to 
solicit comments on the collection.

    Authority: These grants are authorized under section 1110 of the 
Social Security Act. Funding and Congressional language was provided 
in the Consolidated Appropriations Act, 2001 (Pub. L. 106-554) 
(including H.R. 5656 Labor, HHS, and Education Appropriations), and 
in the accompanying Report, H. Conf. Rep. No. 106-1033. HCFA is the 
designated HHS agency with administrative responsibility for this 
grant program.

(Catalog of Federal Domestic Assistance Number: 93.779; Research and 
Demonstrations)

    Dated: May 10, 2001.
Michael McMullan,
Acting Deputy Administrator, Health Care Financing Administration.

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[FR Doc. 01-12882 Filed 5-17-01; 4:37 pm]
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