[Federal Register Volume 67, Number 54 (Wednesday, March 20, 2002)]
[Notices]
[Pages 13000-13001]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-6707]



[[Page 13000]]

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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 funding 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 
$105 million appropriated for the Community Access Program (CAP) under 
the fiscal year 2002 Health and Human Services Appropriations Act. Up 
to $20 million will be available as 1-year CAP grants with the 
possibility of supplemental funding depending on performance and 
funding availability. Current annual awards to communities average 
about $900,000 per award, and range from approximately $150,000 to $1.2 
million. Applicants are encouraged to propose total budgets in this 
range.
    The purpose of this program is to assist communities and consortia 
of health care providers, faith-based organizations and others to 
support the infrastructure necessary to fully develop or strengthen 
integrated health systems of care that coordinate health services for 
the uninsured and underinsured. The goals are to increase access to 
care, generate system-wide efficiency and cost savings, and improve 
health in targeted populations. The coordination of services through 
the CAP grant will allow the uninsured and underinsured to receive more 
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.

DATES: The timeline for application submission, review and award is as 
follows:
    Application kits and additional guidance are available through the 
HRSA Grants Application Center (GAC).

May 7, 2002--Applications due.
June-2002--Applications reviewed.
July-August--Site visits to selected applicants.
September 2002--Grant awards announced.

ADDRESSES: To receive a complete application kit (i.e., application 
instructions, necessary forms, and application review criteria), 
contact the HRSA GAC at:
    Health Resources and Services Administration Grants Application 
Center COMMUNITY ACCESS PROGRAM: CFDA #93.252, 901 Russell Avenue, 
Suite 450, Gaithersburg, MD 20879, Phone: 1-877--HRSA-123, Fax: 1-877-
HRSA-345. E-mail: [email protected].

FOR FURTHER INFORMATION CONTACT: Community Access Program Office, 
Health Resources and Services Administration, 4350 East West Highway, 
3rd Floor, Bethesda, Maryland 20854, Phone: 301-443-0536, Fax: 301-443-
0248. E-mail: [email protected].

SUPPLEMENTARY INFORMATION:

Program Description

    The program has been in existence since FY 2000 with 136 projects 
funded to date. Many communities supported by earlier grants have 
already taken action to meet the health needs of all their residents. 
There are many exciting, dynamic models. Each of the existing CAP 
communities has created a project that addresses its own needs. We are 
interested in funding new communities that plan to generate better 
health for more people at less cost.
    There is no one successful model that we are trying to replicate. 
Some successful communities:
     Have a project design that builds on its current 
capacities and strengths.
     Build coalitions that include the major players in the 
political and health delivery systems.
     Use Federal funds to plan a transition to an expanded 
approach that will be competitive within its own market.
     Have a plan for sustainability after Federal funds expire.
     Have a coalition that works with its county board, city 
council, State legislature and State health programs to ensure 
coordination and efficient use of all available resources.
    CAP requires a coalition/collaboration of partners that includes 
primary, secondary and preventive care. The coalition/collaboration 
should include the providers of safety net services who currently serve 
the community. Many existing CAP coalitions have:
     Coordinated the provision of care through public 
hospitals, public health departments, and Federally Qualified Health 
Centers and existing other federally funded programs like Healthy Start 
and Ryan White;
     Included a strong linkage with social service 
organizations and faith-based programs.
     Linked hospital and clinic services using state of the art 
information technology.
     Developed management systems that allow transitions 
between Medicaid, uninsured, and insured status for low income 
populations to reduce administrative burden on providers.
     Created networks to ensure a primary care home for 
uninsured persons and distributed the caseloads among all providers.
     Linked mental health and substance abuse services to 
primary care.
     Ensured partnership with the local business community.
     Addressed service gaps by expanding health centers.
    Although there are many models emerging, these are not really 
common characteristics but are ``issues frequently addressed.'' They 
are:
     Common enrollment systems.
     Standardized financial eligibility.
     Agreement about sliding fee scales.
     Coordination of services among providers.
     Ensured primary care or medical homes.
     Provision of specialty services.
     Automated appointment systems.
     Case management services.
     Strategies for affordable pharmaceutical services.
     Disease management programs across the array of community 
providers.
     Outreach to hard-to-enroll populations.
     Information systems to implement the desired strategies.
     Included use of local taxing authorities and redirected 
funds within the system to provide for sustainability.
    These communities are demonstrating that these changes are possible 
and they are reporting the results of their efforts across the Nation. 
They are communities with clear goals, an operational plan for meeting 
these goals, a history of commitment to serving indigent populations, 
and a track record to indicate a reasonable chance of success.

Eligible Applicants

    To encourage the development of different models, this program 
seeks a variety of applicants representing all types of communities. 
Applicants who receive funding may be large health care systems or 
small organizations. Applications are encouraged from urban areas, 
rural communities, tribal organizations, and faith-based communities.

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    Applications may be submitted by public and private non-profit 
entities that demonstrate a commitment to and experience with providing 
a coordinated 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 
must consist of partners from all levels of care and partners who 
represent a range of services (e.g., mental health and substance abuse 
treatment, maternal and child health care, oral health, HIV/AIDS care) 
to a wide variety of populations. Coalitions are encouraged to include 
partners from private industry, faith-based organizations, and other 
organizations within communities.
    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.
    Existing CAP grantees are not eligible to apply for this funding.

Application Review and Funding Criteria

    Each of the applications that has passed an eligibility and 
conformance review by Federal staff will be assigned to members of an 
Objective Review Committee (ORC) for review. Members of the ORC will 
use the following evaluation criteria in their review of applications:
    1. Community Needs Assessment--Evidence that the target population 
has significant need (20 Points).
    2. Business Plan to Produce Defined Results--Clarity and scope of 
projected results in terms of increased access to culturally competent 
care and/or health status for the target population, and alignment of 
these projected results with organizational capacity, a clear and 
accountable set of activities, operational plan and budget (30 Points).
    3. Service Integration Strategy & Readiness--Integration of 
appropriate health and other services across the community of providers 
and organizations, readiness, evidence of progress towards developing 
an integrated system of care for the target population, and scope and 
quality of services (25 Points).
    4. Sustainability--Demonstration of existing and sustainable public 
or private funding sources or cost-savings to be generated and 
reinvested in the system of care (15 Points).
    5. Evaluation--Robust self-evaluation plan, specific performance 
measures, and strong commitment to participation in a national 
evaluation (10 Points).
    A Validation Site Visit will be conducted prior to final award 
decisions of those applicants recommended by the ORC for funding. Site 
visits are expected to occur in the July/August timeframe.

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.
     Replication activities and travel to support peer-to-peer 
learning communities.
     Other direct expenses necessary for the integration of 
administrative, clinical, information system, or financial functions.
     Program evaluation activities.
     Case management and disease management activities that are 
not reimbursable services.
    With appropriate justification on why funds are needed to support 
the following costs, up to a total of 15 percent in total of grant 
funds applied for may be used for any combination of the following:
     Alteration or renovation of facilities.
     Primary care site development.
     Service expansions or direct patient care.
    (Direct patient care is defined as provision of services or 
supplies that are ordinarily reimbursable, e.g., exams, therapy 
sessions, pharmaceuticals.)
     Capital equipment used for reimbursable services (e.g., 
radiology equipment, ambulances).
    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:
     Increased access to culturally competent care in terms of 
measures such as: numbers of vulnerable people served, the scope and 
continuity of provided services, the number of new access points such 
as health center expansions or new sites, and other;
     Improved health status in the target population;
     A sustainable system that provides coordinated care to the 
target population; and,
     Elimination of unnecessary, duplicate functions in service 
delivery and administrative functions, resulting in cost savings to 
reinvest in the system.

    Dated: March 12, 2002.
Elizabeth M. Duke,
Administrator.
[FR Doc. 02-6707 Filed 3-19-02; 8:45 am]
BILLING CODE 4165-15-P