[Federal Register Volume 68, Number 103 (Thursday, May 29, 2003)]
[Notices]
[Pages 32063-32067]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-13392]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

[HRSA 03-104]


State Planning Grants (SPG)

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 approximately $15 million to provide 
supplemental grants to States that have previously received planning 
grants in order to assist such States in continuing their data 
gathering, analysis, and planning processes, and to support 
approximately ten new State grants for the development of approaches to 
provide access to health insurance coverage for all State residents. 
This funding has been appropriated under the Fiscal Year (FY) 2003 HHS 
Appropriations Act.
    In FY 2003, HRSA, through its State Planning Grants (SPG) Program, 
will accept applications from (1) States which have previously received 
SPG grant funds to enhance and refine activities already conducted with 
an average grant award of approximately $150,000 and (2) States which 
have never received SPG grant funds with a grant award ranging from 
$800,000 up to $1.2 million. These grants will be used, over a 12-month 
period, (1) to enhance and refine work already conducted with previous 
SPG grant funds; and (2) for new States to identify the characteristics 
of the uninsured within the State and develop approaches for providing 
all uninsured persons with access to health coverage. States will be 
expected to design approaches that provide affordable health insurance 
benefits similar in scope to the Federal Employees Health Benefit Plan, 
Medicaid, coverage offered to State employees, or other similar quality 
benchmarks. Each State receiving such grants must submit the study and 
analysis results in the form of a report to the Department that 
identifies the characteristics of the uninsured within the State and 
proposals for providing them with access to health insurance coverage. 
Together, these reports will provide additional data about the 
characteristics of the uninsured generally and potential models for 
other States seeking to provide comprehensive coverage.
    Where to Request and Send an Application: To obtain the official 
grant application kit (PHS Form 5161-1) contact the HRSA Grants 
Application Center at, 1-877-477-2123, fax: 1-877-477-2345, e-mail: 
[email protected] and request the Office of Management and Budget 
Catalog of Federal Domestic Assistance Number 93.256, Program 
Code SPGP, and HRSA 03-104. Please mail completed applications 
to the HRSA Grants Application Center, 901 Russell Avenue, Suite 450, 
Gaithersburg, MD 20879.
    It is anticipated that there will be a pre-application workshop in 
the Washington, DC area. For more information concerning this workshop, 
contact the SPG Office at 301 443-2309.
    Application Deadline: Applications for grants from States which 
have previously received SPG grant funds must be received in HRSA's 
Division of Grants Management Operations by close of business July 14, 
2003. Applications for grants from States which have never received SPG 
grant funds must be received in the HRSA Grants Application Center by 
close of business July 28, 2003. Applications shall be considered as 
meeting the deadline if they are received on or before the deadline 
date.

FOR FURTHER INFORMATION CONTACT: For further information contact Ms. 
Judy Humphrey, Health Resources and Services Administration, Parklawn 
Building, Room 16C-17, 5600 Fishers Lane, Rockville, MD 20857, Phone: 
(301) 443-2309, Fax: (301) 443-1267, Email: [email protected].

SUPPLEMENTARY INFORMATION: In 2001, 41.2 million people in the United 
States did not have health insurance. This is roughly 1 out of every 6 
non-elderly Americans. Of these, 24.2 million were employed--19.0 
million worked full time and 5.2 million worked part-time. Nationally, 
over 8.5 million children or 11.7 percent are uninsured. Every year, 
approximately a million Americans lose their health coverage. There is 
considerable public and private support for examining and implementing 
new models for providing access to affordable health coverage.
    Many States are currently experiencing fiscal challenges. However, 
covering the uninsured continues to be a priority for many States. 
Every State has responded to the opportunity provided by the State 
Children's Health Insurance Program

[[Page 32064]]

(SCHIP) to implement a program that provides health insurance coverage 
for uninsured low-income children. Many States have also expanded 
Medicaid coverage to uninsured children and adults, using existing 
options, such as section 1115 waiver authority, as well as increased 
flexibility under welfare reform to cover working parents. Eight States 
have used the administration's new Health Insurance Flexibility and 
Accountability (HIFA) initiative, a section 1115 demonstration approach 
announced in August 2001 that emphasizes coverage expansions. Some 
States are working towards enhancing coordination of publicly-funded 
health programs, such as health departments and community health 
centers. States have also undertaken activities that seek to expand 
insurance coverage through mechanisms other than Federally-financed 
programs (e.g., high risk pools and insurance market changes).
    The private sector has expressed an interest in supporting States' 
efforts to expand coverage for the uninsured. The Robert Wood Johnson 
Foundation has implemented the State Coverage Initiatives (SCI), a 
major technical assistance endeavor that will build on the successes 
and lessons learned in its earlier States Initiatives in Health Care 
Reform. The program seeks to improve the practical capacity of State 
governments in their quest to decrease the number of uninsured 
Americans and has an emphasis on policy development and technical 
assistance. The SCI Program provides resources for technical assistance 
that States can use to analyze data, diagnose problems, identify 
solutions, and develop new strategies and policies. It offers small 
policy planning grants and for a few States, larger scale demonstration 
grants.
    In March 2003, a group of health foundations and national 
organizations, including the Robert Wood Johnson Foundation, The 
California Endowment, and the W.K. Kellogg Foundation, conducted an 
educational and advertising campaign entitled Cover the Uninsured Week 
in an effort to sensitize the public and opinion leaders to the plight 
of the more than 41 million Americans who lack health insurance. The 
unprecedented series of national and local activities was designed to 
raise public awareness of the plight of more than 41 million uninsured 
Americans; demonstrate broad support for action on the issue; generate 
significant media attention to the issue, both nationally and in key 
communities across the country; encourage other national organizations 
to join The Robert Wood Johnson Foundation and 18 partner organizations 
in an effort to increase attention to the issue; and create a single 
rallying point for groups and individuals working to extend health care 
coverage to the uninsured.
    At the Federal level, the HHS is committed to assisting States as 
they examine their options for expanding health insurance benefits. By 
providing State planning grants, the HRSA SPG Program intends to 
encourage States to provide access to affordable health insurance 
coverage for all its citizens. Each grantee State will receive 
resources for necessary planning as well as assistance in researching 
and identifying policy options. Together, the results of each State's 
analysis of its uninsured population and its proposals for providing 
these individuals with access to health insurance coverage will provide 
additional data about the characteristics of the uninsured generally 
and present models for other States seeking to provide such 
comprehensive coverage.
    SPG shares some of the same goals as and focus of the Robert Wood 
Johnson Foundation's State Coverage Initiatives and the Health Policy 
Studies Division of the National Governors' Association Center for Best 
Practices. Thus, whenever possible, SPG will coordinate its efforts 
with activities of these programs to share information about insurance 
trends, best practices, data and analyses, and technical assistance.

State Planning Grants for States Which Have Previously Received SPG 
Grant Funds

Program Purpose

    The purpose of supplemental SPG grants for States which have 
previously received SPG grant funds is to assist such States in 
continuing their data gathering, analysis and planning processes. The 
supplemental grant will allow States to enhance, refine, and update the 
work of their initial SPG award to plan to provide all uninsured 
persons with health coverage. Not only will the grantee State benefit 
from further analyses, but by submitting a summary of these analyses 
and proposed plan at the end of the supplemental grant period in an 
addendum report to the Department, other States may learn about 
successful or innovative ways to provide access to coverage. In 
addition, HHS will have the opportunity to review these reports and 
gain insight into effective methods of supporting such endeavors.

Program Goal

    The overarching SPG goal is to encourage States to provide access 
to health insurance coverage to all uninsured citizens by providing the 
resources needed to develop successful plans and to provide a number of 
data collection and planning strategies, along with viable insurance 
expansion options to consider. The immediate goal of SPG for those 
States which have previously received SPG grant funds is to assist such 
States in continuing their data gathering, analysis and planning 
processes for programs that provide health insurance coverage to all 
uninsured citizens in the State through expanded State, Federal, and 
private partnerships.

Program Description

    The approximately $15 million in available funding for all SPG 
grant activities has been appropriated under the FY 2003 Labor-HHS 
Appropriations Act. The HRSA, Office of Special Programs, SPG Program, 
will oversee the program. The program will provide supplemental grants 
to States which have previously received SPG grant funds, whose size 
will vary, with an average grant award of approximately $150,000 for 
the 31 States and 1 Territory which have previously received SPG grant 
funds. The total amount of funds set aside for supplemental grants is 
approximately $4.0 million.
    During FY 2003, SPG will support 1-year supplemental planning 
grants to States which have previously received SPG grant funds to (1) 
as applicable, further collect and analyze data that describe the 
characteristics of their uninsured and assist in the design of 
approaches to provide access to affordable coverage, (2) enhance, 
refine, and/or update the design of a program that would provide all 
uninsured with access to insurance benefits similar in care to State 
employee coverage, Federal Employees Health Benefit Plan, Medicaid or 
other similar quality benchmarks, through a State, Federal, and private 
partnership, (3) prepare an addendum report to the Department 
describing the findings of the new activities and how they relate to 
previously conducted activities, and (4) within 30 days after the end 
of the grant period, provide an addendum report to the Department 
describing any changes to original proposals for an expanded State, 
Federal, and private partnership to cover all of their uninsured.
    The successful State applicant for supplemental SPG grant funds 
will demonstrate a continued commitment to reducing its uninsured 
population; will demonstrate a continued commitment by its Executive 
Branch to studying the possibilities for providing health

[[Page 32065]]

insurance coverage to all uninsured; and will present a comprehensive 
description and justification for the activities proposed to be 
conducted with supplemental SPG grant funds. Activities may include, 
but are not limited to additional data collection, analysis of that 
data, use of the analyses to enhance, refine, and update an approach or 
approaches for covering all uninsured, and a refined strategy for 
implementing and funding that approach. The successful applicant will 
continue to work with all appropriate health-related State agencies, 
including the Medicaid agency, the budget office, and other relevant 
departments (e.g., insurance, public health, human services, mental 
health and substance abuse, and aging). The State applicant should also 
demonstrate continued communication with the health committees in the 
State legislature about the proposal. Formal collaboration should 
continue to exist with private sector organizations (including both 
business and the health care provider communities), consumer groups, 
and researchers.

Eligible Applicants

    All States which have previously received State Planning Grant 
funds are eligible to apply for supplemental funds to assist such 
States in continuing their data gathering, analysis and planning 
processes to enhance and refine existing plans. Only one agency or 
entity may apply per State and it must be a part of the State 
government. A letter from the Governor authorizing this entity or 
agency to apply for the supplemental funds should accompany the 
application, unless the request is from the entity which was awarded 
the original grant.

Funding Criteria

    Review criteria that will be used to evaluate applications from 
States which have previously received State Planning Grant funds 
include the extent to which the application provides:
    A detailed description of activities and results that have been 
accomplished with previously received SPG grant funds.
    A detailed description of the activities proposed to be conducted 
with the supplemental funds and how these activities will enhance and 
build upon the activities already completed and as applicable, be 
integrated with the activities yet to be completed, with the previously 
received SPG grant funds.
    A description of the anticipated results of these proposed tasks 
and how they will expand health insurance coverage options to the 
uninsured.
    A description of the technical capacity, resources, and 
collaboration needed to successfully carry out the proposed activities 
and provide the required report to the Department.
    An accountable management and budget plan with time lines, 
demonstrating readiness of the State government to conduct the proposed 
supplemental activities which will result in new or refined approaches 
to providing access to coverage and determine strategies for 
implementing and funding such approaches. States should provide an 
explanation of how they will contract for needed technical assistance, 
if necessary. For those States with existing State Planning grants, the 
integration of proposed work with work not yet completed is required.
    A description of how the proposed supplemental activities will 
augment earlier efforts to the report to the Department.

Report Contents

    The grant funding provided to States which have previously received 
SPG grant funds, will assist States to enhance and refine models for 
providing access to health insurance coverage for all citizens of the 
State. Each grantee State who receives supplemental SPG grant funds, 
will be required to prepare an addendum report to the Department that 
describes the results of the supplemental activities and how these 
activities have augmented earlier efforts.

Use of Grant Funds

    Funding provided through this program may not be used to substitute 
for or duplicate funds currently supporting similar activities. In 
addition, grant funds may not be used to support construction, 
renovation or modernization costs. However, grant funds may support 
costs such as project staff salaries, consultants, project-related 
travel, project evaluation, limited equipment and software purchases or 
leases, and coordinating project-related meetings.

Expected Results

    The implementation of supplemental State Planning grant funds is 
expected to result in the further development of a plan that the State 
might subsequently implement to provide health insurance coverage to 
all citizens of the State. In addition, the grantee States will provide 
information about data collection activities, partnerships, and options 
that other States may draw from in their efforts to expand health 
insurance coverage.

State Planning Grants for States Which Have Never Received SPG Grant 
Funds

Program Purpose

    The purpose of SPG is to have each new grantee State develop a plan 
or propose options that would ensure every citizen in that State access 
to affordable health insurance benefits similar in scope to the Federal 
Employees Health Benefit Plan, Medicaid, benefits offered to State 
employees or other similar quality benchmarks. Not only will the 
grantee State benefit from its analysis, but by submitting a summary of 
this analysis and proposed plan at the end of the grant period in a 
report to the Department, other States may learn about successful or 
innovative ways to provide access to coverage. In addition, HHS will 
have the opportunity to review these reports and gain insight into 
effective methods of supporting such endeavors.

Program Goal

    The overarching SPG goal is to encourage States to provide access 
to health insurance coverage to all uninsured citizens by providing the 
resources needed to develop successful plans and to provide a number of 
data collection and planning strategies, along with viable insurance 
expansion options to consider. The immediate goal of SPG is to assist 
States as they collect and analyze data, develop coverage options or 
design programs that provide health insurance coverage to all uninsured 
citizens in the State through expanded State, Federal, and private 
partnerships.

Program Description

    The approximately $15 million in available funding for all SPG 
grant activities has been appropriated under the FY 2003 Labor-HHS 
Appropriations Act. The HRSA, Office of Special Programs, State 
Planning Grants Program, will oversee the program. Up to 10 new awards 
are anticipated which will vary in size, with a grant award ranging 
from $800,000 up to $1.2 million. The total amount of funds for new 
grants is approximately $10.0 million.
    During FY 2003, SPG will support one-year planning grants to States 
to (1) collect and analyze data that describe the characteristics of 
their uninsured and assist in the design of approaches to provide 
access to affordable coverage, (2) design a program that would provide 
all uninsured with access to insurance benefits similar in care to 
State employee coverage, Federal Employees Health Benefit Plan, 
Medicaid or other similar quality benchmarks, through a

[[Page 32066]]

State, Federal, and private partnership, (3) prepare a report to the 
Department describing these findings, and (4) within 30 days after the 
end of the grant period, provide the report to the Department 
describing proposals for an expanded State, Federal, and private 
partnership to cover all of their uninsured.
    The successful State applicant will have a demonstrated commitment 
to reducing its uninsured population; will demonstrate commitment by 
its Governor and Executive Branch to studying the possibilities for 
providing health insurance coverage to all uninsured; and will present 
a comprehensive proposal for the kinds of data to be collected, 
analysis of that data, use of the analyses to create an approach for 
covering all uninsured, and a strategy for implementing and funding 
that approach. The successful applicant will work with all appropriate 
health-related State agencies, including the Medicaid agency, the 
budget office, and other relevant departments (e.g., insurance, public 
health, human services, mental health and substance abuse, and aging). 
If possible, the applicant should demonstrate communication with the 
health committees in the State legislature about the proposal. Formal 
collaboration must exist with private sector organizations (including 
both business and the health care provider communities), consumer 
groups, and researchers.
    We are looking for applicants with a clear commitment to the goal 
of providing coverage to all uninsured and an operational plan for 
using these planning grants to help achieve that goal. As such, funded 
State planning grants will contain these common elements:
    A goal of providing access to affordable health insurance coverage 
to all citizens in the State--Access to affordable coverage for this 
grant program means that individuals or families have the opportunity 
to purchase health insurance coverage or participate in a program that 
provides adequate benefits at an affordable cost. States may ensure 
``affordability'' by determining cost-sharing based on the 
beneficiary's income level and applying a sliding scale related to 
income, or implementing other cost-sharing protections such as spending 
caps. For example, in non-Medicaid SCHIP programs, for children in 
families with income levels above 150 percent of the Federal poverty 
line, cost-sharing may be imposed on a sliding scale related to income, 
but the total annual aggregate cost-sharing for all targeted low-income 
children in the family cannot exceed 5 percent of the family's annual 
income.
    Citizens of the State--If Federal funds are proposed to be used, 
States should plan their coverage options based on existing Federal 
eligibility criteria for participation in the Medicaid, SCHIP, and 
Medicare programs. States may use State funds or other resources to 
cover non-citizen residents.
    Commitment to eliminating the number of uninsured--Grantee States 
must demonstrate prior efforts, whether or not approved by their State 
Legislatures, to reduce their number of uninsured through program 
expansions, data collection activities to support further expansions 
and/or other activities demonstrating a commitment to providing 
increased access to health insurance for its citizens.
    Collaboration among State, Federal, and private partners--Grantee 
States should build upon current collaborations among State, Federal, 
and private partners for expanding health insurance coverage to all 
citizens within the State. States are encouraged to consult with Tribal 
governments, where appropriate. These collaborations should be formal 
and should include the leadership of public and private partners.
    Capacity for data collection and analysis--Grantee States should 
demonstrate data collection and analytical capacity or a detailed plan 
for acquiring this technical assistance, including a commitment from 
the agency/organization to provide this technical assistance. States 
are encouraged to work with the many existing Federal and State data 
collection activities, as well as ongoing efforts in the private, non-
profit sector.

Eligible Applicants

    Eligibility for new grants is limited to States which have never 
received SPG grant funds with only one application per State permitted. 
Each Governor is asked to designate the entity or agency responsible 
for preparing the State's grant application. The entity or agency must 
be a part of the State government. A letter from the Governor 
authorizing this entity or agency to prepare the State's application 
should accompany the application.

Funding Criteria

    Review criteria that will be used to evaluate applications from 
States which have not previously received State Planning Grant funds 
includes:
    Evidence of commitment by the Governor, State agencies, and public 
and private health care providers to provide coverage to all uninsured.
    Evidence of prior data collection and analysis resulting in efforts 
to expand coverage to the uninsured.
    Evidence of meaningful collaboration between the agencies and 
constituencies in the public and private sectors necessary to 
successfully complete the analysis and submit the required report to 
the Department.
    A demonstrated understanding of the technical capacity, resources, 
and collaboration necessary to successfully carry out the proposed 
analysis and provide the required report to the Department.
    An accountable management and budget plan with time lines, 
demonstrating readiness of the State government to conduct the data 
collection, analyze the data, develop approaches to providing access to 
coverage, and determine strategies for implementing and funding such 
approaches. States should provide an explanation of how they will 
contract for needed technical assistance, if necessary.

Report Contents

    The new grant funding provided to States, which have not previously 
received SPG grant funds, will assist States to develop models for 
providing access to health insurance coverage for all citizens of the 
State. As a result, each grantee State will prepare a report to the 
Department that provides:
    A detailed plan for data collection and analysis, upon which the 
State will base its design for covering its uninsured.
    Its strategy for gaining collaboration and consensus among State, 
Federal, and private partners on options to expand health insurance 
coverage to all citizens.
    Options for expanding health insurance coverage through State, 
Federal, and private partnerships. The following options and issues are 
areas that the State may wish to address, if relevant in the State. 
These options and issues include (1) targeting expansion groups such as 
parents of SCHIP children, young adults ages 19-20, and early retirees; 
(2) delivery systems; (3) administration; (4) outreach; (5) eligibility 
levels; (6) eligibility determination process; (7) enrollment process; 
(8) marketing plan; (9) coverage and benefits (similar to State, 
Federal employees, Medicaid, and other credible coverage); (10) 
portability; (11) cost-sharing (co-pays, premiums); (12) integration 
with existing public and private programs (e.g., Medicaid, Medicare, 
and SCHIP coverage, State programs, projects proposed through the 
Community Access Program); (13) plans

[[Page 32067]]

for studying or avoiding crowd-out-interaction with employer-sponsored 
insurance; (14) cost-containment; (15) ensuring quality; (16) ensuring 
access; (17) data collection; (18) audits; (19) program budget; (20) 
program evaluations; (21) funding; (22) maintenance of effort; (23) 
necessary waivers (under existing program authority); (24) necessary 
State or Federal legislative changes (not under current authority); and 
(25) private sector options (e.g., high risk pools, employer options, 
market reforms). States that propose or prepare waivers or State plan 
amendments (e.g., Medicaid waivers, SCHIP amendments) as a result of 
their grant activities must submit their requests through existing 
review processes established by the Centers for Medicare and Medicaid 
Services.

Use of Grant Funds

    Funding provided through this program may not be used to substitute 
for or duplicate funds currently supporting similar activities. In 
addition, grant funds may not be used to support construction, 
renovation or modernization costs. However, grant funds may support 
costs such as project staff salaries, consultants, project-related 
travel, project evaluation, limited equipment and software purchases or 
leases, and coordinating project-related meetings.

Expected Results

    The implementation of State Planning grants is expected to result 
in the development of a plan that the State might subsequently 
implement to provide health insurance coverage to all citizens of the 
State. In addition, the grantee States will provide information about 
data collection activities, partnerships, and options that other States 
may draw from in their efforts to expand health insurance coverage.
    Paperwork Reduction Act: Should any data collection activities fall 
under the purview of the PRA, OMB clearance will be sought. PHS Form 
5161.1--CFDA 93.256.

    Dated: May 22, 2003.
Elizabeth M. Duke,
Administrator.
[FR Doc. 03-13392 Filed 5-28-03; 8:45 am]
BILLING CODE 4165-15-P