[Federal Register Volume 68, Number 104 (Friday, May 30, 2003)]
[Notices]
[Pages 32520-32526]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-13582]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10086]


Emergency Clearance: Notice of Funding Availability and Public 
Information Collection Requirements Submitted to the Office of 
Management and Budget (OMB)

AGENCY: Centers for Medicare & Medicaid Services (CMS).

SUMMARY: Part I of this notice serves as an announcement for emergency 
clearance of public information collection requirements that have been 
submitted to the Office of Management and Budget (OMB). The Congress 
recognized that States face formidable challenges in their efforts to 
fulfill their legal responsibilities under the Americans with 
Disabilities Act. The Congress appropriated funds for these ``Real 
Choice Systems Change Grants'' specifically to improve community-
integrated services. We cannot reasonably comply with the normal 
clearance procedures because of the potential for public harm: the 
funds set aside for the grants would revert to the general fund and 
States, together with their disability and aging communities that have 
already undertaken extensive planning efforts for these grant 
opportunities, would be significantly harmed.
    Part II of this notice serves as an announcement for solicitation 
of applications for the Real Choice Systems Change Grants for Community 
Living. Specifically, this notice announces the availability of 
approximately $35 million in grant funding. These grants are a part of 
the President's New Freedom Initiative, which calls for the removal of 
barriers to community living for people with disabilities. CMS is the 
designated HHS agency with administrative responsibility for this 
program. These grants are designed to assist states 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. Also included in this 
notice is information about the application process.
    A second Federal Register notice is being published regarding the 
remaining $5 million of the Real Choice Systems Change Grants for 
Community Living. In the second notice, the Centers for Medicare & 
Medicaid Services, in collaboration with the Administration on Aging, 
will announce a competition for grants to be awarded as cooperative 
agreements for projects that support the development of state Aging and 
Disability Resource Center (Resource Center) programs. Resource Center 
programs will provide person-centered ``one-stop shop'' entry points 
into the long-term care system at the community level. Resource Centers 
will serve individuals who need long-term care, their family 
caregivers, and those planning for future long-term care needs. They 
will also serve as a resource for health and long-term care 
professionals and others who provide services to the elderly and to 
people with disabilities.

DATES: Deadline for Submission of Grant Applications: To be considered 
under the Fiscal Year 2003 funding cycle, grant applications must be 
submitted by July 29, 2003. All application materials must be submitted 
by the due date. No materials will be accepted after the deadline. The 
types of grants and maximum grant awards are summarized in the Real 
Choice Systems Change Grants for Community Living--FY2003 table.
    Applicants' Teleconference (aka: Bidders' Teleconference): 
Information regarding the time and call-in number will be available on 
the CMS Web site at: http://www.cms.hhs.gov/newfreedom/default.asp. We 
anticipate that the teleconference will be scheduled early in the month 
of June. Additionally, CMS staff will be available for questions and 
answers on an ongoing basis.

Application Materials:  An application kit containing all instructions 
and forms needed to apply for the Real Choice Systems Change Grants for 
Community Living can be downloaded from the New Freedom Initiative Web 
site at: http://www.cms.hhs.gov/newfreedom/default.asp. If an 
organization does not have access to the Internet, an application kit 
may be obtained by writing or calling: Judith Norris, Centers for 
Medicare & Medicaid Services, OICS, AGG, Grants Management Staff, Mail 
Stop C2-21-15, 7500 Security Boulevard, Baltimore, Maryland 21244-1850; 
E-mail: [email protected]; 410-786-5130.

Submission of Application: Applications are due by the closing date 
listed under Deadline for Submission of Grant Applications in the DATE 
section of this notice. Applications must be submitted both 
electronically and in paper form. Applications mailed through the U. S. 
Postal Services 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.
    Submissions by facsimile (fax) transmission will not be accepted. 
An original proposal should be submitted with two copies to: Marian 
Webb, Centers for Medicare & Medicaid Services, OICS, AGG, Grants 
Management Staff, Mail Stop: C2-21-15, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850. Additional application instructions are 
included in the solicitation.
    Applicants will not receive official notification that their 
application has been received on time by CMS. Those submitting late 
applications will be notified that their applications were not 
considered in the competition and will be returned without review.

FOR FURTHER INFORMATION CONTACT: Questions about CMS's announcement of 
funding availability or application

[[Page 32521]]

package can be directed to: Mary Guy, Centers for Medicare & Medicaid 
Services, Center for Medicaid and State Operations, Disabled and 
Elderly Health Programs Group, Mail Stop: S2-14-26, 7500 Security 
Boulevard, Baltimore, MD 21244-1850, (410) 786-2772, E-mail: 
[email protected].

SUPPLEMENTARY INFORMATION: 

Part I--Paperwork Reduction Act Notice

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS) (formerly known as the Health Care Financing 
Administration (HCFA)), Department of Health and Human Services, is 
publishing the following summary of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
burden estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the agency's functions; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    CMS is requesting an emergency review of the information collection 
referenced below. In compliance with the requirement of section 
3506(c)(2)(A) of the Paperwork Reduction Act of 1995, we have submitted 
to the Office of Management and Budget (OMB) the following requirements 
for emergency review. CMS is requesting an emergency review because the 
collection of this information is needed before the expiration of the 
normal time limits under OMB's regulations at 5 CFR Part 1320. This is 
necessary to ensure compliance with the Trade Act of 2002. CMS cannot 
reasonably comply with the normal clearance procedures because of an 
unanticipated event and potential public harm.
    CMS seeks emergency approval because of the short timeframe that is 
available to issue the solicitation, receive and applications, and 
prepare and release award packages. Because of the increased number of 
grant opportunities, we are expecting an even larger volume of grant 
applications than was received for this program in FY 2001.
    CMS is requesting OMB review and approval of this collection by 
July 21, 2003 with a 180-day approval period. Written comments and 
recommendations will be accepted from the public if received by the 
individuals designated below by July 16, 2003. During this 180-day 
period, we will publish a separate Federal Register notice announcing 
the initiation of an extensive 60-day agency review and public comment 
period on these requirements. We will submit the requirements for OMB 
review and an extension of this emergency approval.
    Type of Information Request: New collection; Type of Information 
Collection: Medicaid Program: Real Choice Systems Change Grants for 
Community Living; CMS Form Number: CMS-10086 (OMB 0938-NEW); 
Use: Executive Order 13217, ``Community-Based Alternatives for 
Individuals with Disabilities'' called upon the federal government to 
assist states and localities to swiftly implement the decision of the 
United States Supreme Court in Olmstead v. L.C., stating: ``The United 
States is committed to community-based alternatives for individuals 
with disabilities and recognizes that such services advance the best 
interests of the United States.'' State agencies and community groups 
will be applying for these grants; Frequency: On occasion; Affected 
Public: State, local, or tribal government; not-for-profit 
institutions; Number of Respondents: 150 Total Annual Responses:150; 
Total Annual Burden Hours: 1500. CMS has submitted a copy of this 
notice to OMB for its review of these information collections. A notice 
will be published in the Federal Register when approval is obtained.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS's 
Web site address at http://cms.hhs.gov/regulations/pra/default.asp or 
E-mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to [email protected], or call the 
Reports Clearance Office on (410) 786-1326.
    Interested persons are invited to send comments regarding the 
burden or any other aspect of these collections of information 
requirements. However, as noted above, in order to be considered in the 
OMB approval process, comments on these information collection and 
record keeping requirements must be mailed and/or faxed to the 
designees referenced below, by July 16, 2003.

Part II--Announcement for Solicitation of Applications for the Real 
Choice Systems Change Grants for Community Living

A. Background

    1. 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 
decisions about their own 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. 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 long-term support 
systems to respond to the desires of the 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. The President invigorated these 
efforts in 2001 through his New Freedom Initiative and Executive Order 
13217. The Executive Order directs Federal agencies to provide 
assistance to States and to identify federal policy barriers that might 
be removed in order to achieve fulfillment of ADA.
    2. FY 2001 Real Choice Systems Change Grants for Community Living: 
On May 22, 2001, CMS published a Notice of Funding Availability for the 
Systems Change Grants for Community Living in the Federal Register (66 
FR 28183). Under that notice, CMS invited proposals from states and 
others, in partnership with their disability and aging communities, to 
design and implement effective and enduring improvements in community 
long-term support systems. The response of states and other eligible 
entities to these grant opportunities was extraordinary. The response 
revealed a strong interest by states and others in improving community-
based systems and for federal technical and resource

[[Page 32522]]

assistance. In July 2001, CMS received 161 applications for these 
Systems Change grants from 51 States and Territories (48 States, the 
District of Columbia, and 2 Territories) requesting funding totaling 
approximately $240 million. In September 2001, CMS awarded the first 
Real Choice Systems Change Grants, totaling approximately $70 million, 
to 37 States and 1 territory. The awards consisted of: 25 Real Choice 
Systems Change grants; ten Community-Integrated Personal Assistance 
Services and Supports grants; 12 Nursing Facility Transitions, State 
Program Grants; and five Nursing Facility Transitions, Independent 
Living Partnership grants. CMS also awarded two grants (one to each 
grantee) for technical assistance to Rutgers and ILRU, forming the 
Community Living Exchange Collaborative: A National Technical 
Assistance Program.
    3. FY 2002 Real Choice Systems Change Grants for Community Living: 
In FY 2002, the Congress appropriated an additional $55 million in 
Systems Change grant funds specifically to improve community-integrated 
services (Departments of Labor, Health and Human Services, and 
Education, and Related Agencies Appropriations Act, 2002 Pub. L. 107-
116). Due to the extraordinary response CMS received in FY 2001 to the 
Systems Change Grants for Community Living solicitation, no new 
applications were accepted for FY 2002. Instead, CMS continued to 
process and award applications submitted in 2001, beginning with the 
highest-ranked applications that were not funded in FY 2001. Notice of 
the process for awarding the FY 2002 grants was published in the 
Federal Register on April 26, 2002 (66 FR 20791). The FY 2002 awards 
consisted of: 25 new Real Choice Systems Change grants; 8 new 
Community-Integrated Personal Assistance Services and Supports grants; 
11 new Nursing Facility Transitions, State Program grants; and 5 new 
Nursing Facility Transitions, Independent Living Partnership grants. 
CMS also made supplemental awards to the two the Grantees for the 
Community Living Exchange Collaborative: A National Technical 
Assistance Program and five supplemental awards to five states that 
received Real Choice Systems Change grants in FY 2001. The five 
supplemental Real Choice awards ensured that these state grantees were 
not disadvantaged in award amounts received compared to states that 
received FY 2002 awards. The list of ``Qualified Applicants'' for 
purposes of FY 2002 grant awards as published was correct with the 
following exception: the State of California declined its 
``preliminary'' award of a Nursing Facility Transitions, State Program 
Grant (NFT-SP) and as a result, the State of Louisiana, the next 
highest-ranked applicant in this category, was awarded an NFT-SP grant.

B. Overview and General Requirements for All FY 2003 Real Choice System 
Change Grants for Community Living

    The following distinct competitive grant solicitations comprise the 
Real Choice Systems Change Grants for Community Living:
    [sbull] Respite for Adults: The purpose of the Respite for Adults 
grants is to enable states to conduct studies assessing the feasibility 
of developing respite projects for caregivers of adults through 
Medicaid or other funding streams. States may examine the feasibility 
of providing respite for adults, as if it were a Medicaid service, to a 
limited target group (i.e., the elderly; individuals with mental 
illness, developmental disability, physical disability, etc.) Such 
projects will be expected to build in elements that are responsive to 
individual needs and offer the opportunity for consumer direction. 
Approximately $525,000 to $1.4 million is available to assist states in 
this effort.
    [sbull] Respite for Children: The purpose of the Respite for 
Children grants is to enable States to conduct feasibility studies and 
explore the development for Medicaid respite projects specifically 
targeted for caregivers of children. States may examine the feasibility 
of providing respite for children, as if it were a Medicaid service, to 
a limited target group (i.e., children with a physical disability, 
mental illness, developmental disability, etc.) Such projects will be 
expected to build in elements that are responsive to individual needs 
and offer the opportunity for consumer direction. Approximately 
$525,000 to $1.4 million is available to assist states in this effort.
    [sbull] Community-Based Treatment Alternatives for Children (C-
TAC): The purpose of the C-TAC grants is to assist states in developing 
a comprehensive, community-based mental health service delivery system, 
through Medicaid, for children with serious emotional disturbances who 
would otherwise require care in a psychiatric residential treatment 
facility (PRTF). Currently, Medicaid provides inpatient psychiatric 
services for children under age 21 in hospitals, and extends these 
Medicaid benefits to children in PRTFs. However, PRTFs do not meet the 
CMS definition of ``hospital'' so they do not qualify as institutions 
against which states may measure Sec.  1915(c) waiver costs. Over the 
last decade, PRTFs have become the primary providers for children with 
serious emotional disturbances requiring an institutional level of care 
however, states have been unable to use Sec.  1915(c) waiver authority 
to provide Medicaid-funded home and community-based alternatives to 
care, which would keep the children in their homes and with their 
families. The funds available through this solicitation will assist 
states in assessing community-based alternatives to residential 
treatment or institutionalization. Approximately $525,000 to $1.4 
million is available to assist states in this effort.
    [sbull] Quality Assurance and Quality Improvement in Home and 
Community-Based Services (QA/QI in HCBS): The purpose of QA/QI in HCBS 
grants is to assist states to: (a) fulfill their commitment to assuring 
the health and welfare of individuals who participate in the state's 
home and community-based waivers under Sec.  1915(c) of the Social 
Security Act, (b) develop effective and systematic methods to meet 
statutory and CMS requirements by the use of ongoing quality 
improvement strategies, and (c) develop improved methods that enlist 
the individual and community members in active roles in the quality 
assurance and quality improvement systems. Approximately $4,320,000 to 
$15 million is available to assist states in this effort.
    [sbull] Independence Plus Initiative: The purpose of Independence 
Plus Initiative grants is to assist states in meeting the federal 
expectations established by CMS for the approval of self-directed 
program waivers and demonstration projects within the Independence Plus 
framework. These expectations include: Person-Centered Planning, 
Individual Budgeting, Self-Directed Supports (including Financial 
Management Services and Supports Brokerage), and Quality Assurance and 
Improvement Systems (including the participant protections of emergency 
back-up and viable incident management systems). Approximately 
$2,880,000 to $8 million is available to assist states in this effort.
    [sbull] Money Follows the Person Rebalancing Initiative: The 
purpose of this initiative is to enable states to develop and implement 
strategies to reform the financing and service designs of state long-
term support systems so that (a) a coherent package of State Plan and 
HCBS waiver services is available in a manner that permits funding to 
``follow the person'' to the most appropriate and preferred setting, 
(b) financing arrangements that enable transition services for 
individuals who transition between institution and

[[Page 32523]]

community settings. Approximately $5.5 million to $15 million is 
available to assist states in this effort.
    [sbull] Community-Integrated Personal Assistance Services and 
Supports (C-PASS): 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. 
Approximately $1.6 million to $6 million is available to assist states 
that did not receive a C-PASS grant in either FY 2001 or FY 2002. FY 
2001 C-PASS grantees are: Alaska, Arkansas, Guam, Michigan, Minnesota, 
Montana, Nevada, New Hampshire, Oklahoma, and Rhode Island. FY 2002 C-
PASS grantees are: Colorado, District of Columbia, Hawaii, Indiana, 
Kansas, North Carolina, Tennessee, and West Virginia. Only states that 
did not receive a C-PASS grant in either FY 2001 or FY 2002 are 
eligible to apply for FY 2003.
    [sbull] National State-to-State Technical Assistance Program for 
Community Living: This national technical assistance grant will support 
all of the FY 2003 Real Choice Systems Change Grants for Community 
Living efforts. CMS expects that the grantee will engage in activities 
that include: (a) Providing technical assistance to the FY 2003 Real 
Choice Systems Change grantees, the Technical Assistance for Consumer 
Task Forces grantee, and others; (b) providing on-site state-to-state 
technical assistance; (c) developing technical assistance materials; 
(d) developing or providing expertise for states and children and 
adults of any age with a disability or long-term illness; (e) working 
with individual states, national associations of state agencies, 
consumer organizations, the National Governors Association, the 
National Conference of State Legislatures, and others to collect, 
refine, and disseminate information that aids in the effective 
administration of programs for community living; and (f) developing, 
gathering, analyzing, and disseminating relevant practical information. 
Approximately $4.4 million is available for this grant.
    [sbull] Technical Assistance for Consumer Task Forces: The purpose 
of this grant, as emphasized by Congress, is to ``provide expanded 
technical assistance to the consumer task forces involved with the Real 
Choice Systems Change Grant program by contracting with a consortium of 
consumer-controlled organizations for people with disabilities.'' 
Ensuring technical assistance by and for consumers on consumer task 
forces is one way to support the involvement of crucial stakeholders in 
the Real Choice Systems Change Grants for Community Living. Under this 
grant opportunity, CMS is accepting proposals from consortia of 
consumer-controlled organizations to provide technical assistance to 
the consumer task forces of the Grantees of Real Choice Systems Change 
Grants for Community Living Project funds may be used to organize and 
provide technical assistance to the consumer task forces that are 
involved with planning and implementation of the grants funded under 
the Real Choice Systems Change Grants for Community Living. Project 
funds may be used, for example, to hire staff for this project, to hire 
contractor(s) to contribute to the project, to hold meetings, for 
travel, for publications, for training and development of new programs, 
and to facilitate the progress of the consumer task forces. 
Approximately $550,000 is available for this grant.
    [sbull] Family-to-Family Health Care Information and Education 
Centers: The purpose of these grants is to support the development of 
Family-to-Family Health Care Information and Education Centers 
(Information and Education Centers). Organizations will use these 
awards to establish statewide family-run centers that will (a) provide 
education and training opportunities for families with children with 
special health care needs, (b) develop and disseminate needed health 
care and HCBS information to families and providers, (c) collaborate 
with other Family-to-Family Health Care Information and Education 
Centers to benefit children with special health care needs, and (d) 
promote the philosophy of individual and family-directed supports CMS 
is collaborating with the Health Resources and Services Administration 
(HRSA) in this initiative. In 2001, the HRSA, Maternal and Child Health 
Bureau, initiated a program to develop the capacities of families with 
children with special health care needs and assist states meet their 
Healthy People 2010 objectives for community-based services for 
children with special health care needs. The HRSA program is also 
entitled Family-to-Family Health Care Information and Education 
Centers. (For information on the Healthy People 2010 initiative, please 
visit the Web site at: http://www.healthypeople.gov.) CMS recognizes 
the wealth of knowledge that exists among parents who have years of 
experience with the long-term care system, and the potential for this 
knowledge to be of assistance to both other families and service 
providers. The goals of this initiative are to increase both access to 
and choice in HCBS for families who have children with special health 
care needs. Applicants must demonstrate that the project (a) 
establishes new capacity, (b) does not duplicate existing work or 
supplant existing funding, and (c) devotes all funding under the new 
proposal to endeavors that advance the goal and vision of the 
Information and Education Centers grant program. Approximately $875,000 
to $1.1 million is available for these efforts.
    1. Amount and Number of Grants to be Awarded: The Real Choice 
Systems Change Grants for Community Living--FY 2003 table indicates the 
expected range of awards for each type of grant. CMS reserves the right 
to offer a funding level that differs from the requested amount, and to 
negotiate with the applicant with regard to the appropriate scope and 
intensity of effort that would be appropriate and commensurate with the 
final funding level.
    2. Purpose: Several grant opportunities comprise the FY 2003 Real 
Choice Systems Change Grants for Community Living solicitation. They 
are described in this notice and more fully in the solicitation. Some 
of these grants are intended to assist states in assessing and 
exploring how to best address problems in specific topic areas that CMS 
has learned are of great concern through the New Freedom Initiative, 
National Listening Session, and Open Door Forums. Other grants are 
intended as catalysts for the development of specific home and 
community-based waivers (i.e., Independence Plus) or for the 
development of systems of quality assurance and quality-improvement 
within existing home and community-based waivers. The new C-PASS grants 
will enable states that have not previously received a C-PASS grant to 
improve personal assistance services and supports that are consumer-
directed or offer maximum individual control.
    3. Who is Eligible to Apply: States may apply for any grant except 
the Technical Assistance for Consumer Task Forces and the Family-to-
Family Health Care Information and Education Centers grants. 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

[[Page 32524]]

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 the Commonwealth of the Northern Mariana Islands.
    Any state agency or instrumentality may apply for funding under the 
various grant opportunities except the Technical Assistance for 
Consumer Task Forces and the Family-to-Family Health Care Information 
and Education Centers grants. If an application is from an applicant 
that is not the Single State Medicaid Agency, a letter of endorsement 
from the Governor, State Medicaid Director, or Agency administering a 
relevant section of the 1915(c) home and community-based waiver must 
accompany the application; this requirement does not apply to 
applicants for the National State-to-State Technical Assistance Program 
for Community Living or the Technical Assistance for Consumer Task 
Forces grants.
    In the 2001 solicitation, any entity was able to apply for the C-
PASS grants, which are to be awarded at the rate of one per State. 
There are still a number of states that have not received C-PASS 
grants. Based upon this year's allocation of funding, and consistent 
with the intent of the original 2001 solicitation, CMS will to retain 
the rate of one C-PASS grant award per state. This decision will enable 
more states to participate in this important program. Thus, the 
following states that received a C-PASS grant in FY 2001 or FY 2002 are 
ineligible to apply for FY 2003 C-PASS funding:
    [sbull] FY 2001 C-PASS grantees: Alaska, Arkansas, Guam, Michigan, 
Minnesota, Montana, Nevada, New Hampshire, Oklahoma, and Rhode Island; 
and
    [sbull] FY 2002 C-PASS grantees: Colorado, District of Columbia, 
Hawaii, Indiana, Kansas, North Carolina, Tennessee, and West Virginia.
    For additional information on the FY 2001 and FY 2002 C-PASS 
grantees, please visit our contractor's Web site at: http://www.hcbs.org.
    Any entity may apply for the Technical Assistance for Community 
Living Grant.
    Any nonprofit organization as defined in HHS GPD 1.02 B as ``[a] 
corporation or association whose profits may not lawfully accrue to the 
benefit of any private shareholder or individual'' may apply for the 
Family-to-Family Health Care Information and Education Center grant. 
Nonprofits whose mission includes services to families with children 
with special health care needs and whose Board of Directors has a 
majority of parents of children with special health care needs are 
especially encouraged to apply. Only one application per state will be 
accepted for this type of grant. Applicants for this type of grant must 
also have a letter of endorsement from the State Medicaid Director or 
the Governor. In addition, states that currently operate Family-to-
Family Family Health Care Information and Education Centers (funded 
through the Health Resources and Services Administration) are 
ineligible for funding under this initiative.
    Only consortia of consumer-controlled organizations may apply for 
the Technical Assistance for Consumer Task Forces Grant. ``Consumer-
controlled organization'' means an organization that is governed by 
individuals who have a disability or long-term illness. Individuals of 
any age who rely upon long-term supports and services as a result of a 
disability or long-term illness must represent more than half of such 
organization's Board of Directors or other controlling structure.
    Consortia that apply for this technical assistance grant must 
represent individuals who have disability or long-term illness (e.g., 
people with a developmental disability, mental retardation, mental 
illness, physical disabilities) and those who are elderly. Since one 
organization may not possess the required expertise for all target 
groups, we expect the consortia to address the need for commitment from 
a significant number of highly knowledgeable individuals and 
organizations. It is not necessary for the consortia to have existed 
prior to this project. It can be an entity that has organized for 
purposes of applying for this grant, although one organization must 
have the capacity to receive the grant award and serve as the project 
lead.
    States may and are encouraged to apply for more than one of the 
several different types of grant. For example, a state may apply for a 
Respite for Children and also for a Money Follows the Person 
Rebalancing Initiative grant. Also, different state agencies may apply 
for different grant opportunities. For example, the Single State 
Medicaid agency might apply for the C-PASS grant and the agency 
administering the section 1915(c) waiver might apply for the Money 
Follows the Person Rebalancing Initiative Grant. However, no state may 
be awarded more than one grant per state per type of grant opportunity. 
For example, a state may not receive two C-PASS grants, two Respite for 
Children grants, or two Independence Plus Initiative grants. In 
addition, if an applicant submits the same scope of work or similar 
activities under more than one of this year's grant opportunities, or 
activities are currently funded under existing grants, CMS will not 
consider the application for funding. CMS also reserves the right not 
to fund an application that, in its estimation, duplicates existing 
efforts regardless of the applicant's ranking by reviewers.
    Faith-based organizations are encouraged to apply for the National 
State-to-State Technical Program for Community Living, Technical 
Assistance for Consumer Task Forces, and the Family-to-Family Health 
Care Information and Education Centers Grants.
    CMS will not fund through this round of grants those efforts or 
activities that are already being funded under an existing Real Choice 
Systems Change Grant (funded in FY 2001 or FY 2002) or other grants. If 
a grantee proposes to significantly expand an earlier-funded project, 
the applicant must specifically describe this expansion in its 
application. CMS does encourage states to seek private sector grant 
opportunities (e.g., grants from foundations) to augment or coordinate 
with the Real Choice Systems Change Grants for Community Living.
    In the event that CMS receives more than one application for any 
grant opportunity for which the ``one per state'' standard applies, CMS 
reserves the right to select which application to consider for funding.
    CMS reserves the right to assure reasonable balance in the awarding 
of grants in terms of key factors such as geographic distribution and 
broad target group representation. CMS also reserves the right to 
redistribute grant funds based upon the number and quality of 
applications per type of grant (e.g., to adjust the minimum or maximum 
awards permitted or adjust the aggregate amount of federal funds 
allotted to a particular category of grants).
    4. Match Requirements: Grantees are required to make a non-
financial recipient contribution of five percent (5%) of the total 
grant award (including all direct and indirect costs). Non-financial 
recipient contributions may include the value of goods and/or services 
contributed by the Grantee (e.g., 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 in Item 15 (Estimated 
Funding) on Standard Form 424A and described in the budget narrative/
justification section of the application. The non-financial

[[Page 32525]]

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% of the total grant award (including all direct and indirect 
costs). 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.
    Intergovernmental Review of Federal Programs--''Intergovernmental 
Review of Federal Programs,'' Executive Order 12372 (45 CFR Part 100), 
does not apply to this solicitation.


    Authority:  The Real Choice Systems Change Grants for Community 
Living are authorized pursuant to Sec.  1110 of the Social Security 
Act. Section 1110 (a)(1)(A) of the Social Security Act authorizes 
CMS make ``grants to States and public and other organizations and 
agencies for paying part of the cost of research or demonstration 
projects such as those * * * which will help improve the 
administration and effectiveness of programs carried on or assisted 
under the Social Security Act and programs related thereto * * *'' 
CMS has structured its efforts under Sec.  1110 into eight themes. 
The Real Choice Systems Change Grants are part of CMS's Research and 
Demonstration efforts under Theme 5: Strengthening Medicaid, State 
Children's Health Insurance Program (SCHIP), and State Programs. 
This effort includes research on ways to improve access to and 
delivery of health care to the persons served by Medicaid. These 
particular grants also support the President's New Freedom 
Initiative, which calls for the removal of barriers to community 
living for people with disabilities. Funding and Congressional 
language was provided in the Consolidated Appropriations Resolution, 
2003 (Pub. L.108-7). Although Congress appropriated $40 million in 
funding for a new round of Real Choice Systems Change Grants for 
Community Living for FY 2003, Congress also passed a 0.65% general 
reduction in the 2003 appropriation that was distributed across 
federal programs, including this appropriation, so the final amount 
available is slightly less than $40 million.

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development 
and Issuances, Attn: Reports Clearance Officer, 7500 Security 
Boulevard, Mail Stop: C5-16-03, Baltimore, MD 21244-1850. Fax Number: 
(410) 786-3064. Attn: Julie Brown;
     and,
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503. Fax Number: (202) 395-6974 or (202) 395-5167. Attn: Brenda 
Aguilar, CMS Desk Officer.

    Dated: May 27, 2003.
Dawn Willinghan,
Acting CMS Reports Clearance Officer, Office of Strategic Operations 
and Strategic Affairs, Division of Regulations Development and 
Issuances.

                                             Real Choice Systems Change Grants for Community Living--FY 2003
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                      Max.  number
                                                                        of  grant                                                   Percent
                                                      Who may apply?   awards  per    Maximum    Anticipated  Maximum  projected   allowable   Estimated
      Grant opportunity        Application deadline        \1\          State per      award       average           period       for direct   number of
                                                                         type of                    award                           services    awards
                                                                          grant                                                       \2\
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                       Feasibility Studies and Development Grants
--------------------------------------------------------------------------------------------------------------------------------------------------------
1. Respite for Adults (CFDA    July 29, 2003.......  Any State                   1    $100,000       $75,000  Up to 36 mos......           0        7-14
 93.779).                                             Agency or
                                                      Instrumentalit
                                                      y.
2. Respite for Children (CFDA  July 29, 2003.......  Any State                   1     100,000        75,000  Up to 36 mos......           0        7-14
 93.779).                                             Agency or
                                                      Instrumentalit
                                                      y.
3. Community-Based Treatment   July 29, 2003.......  Any State                   1     100,000        75,000  Up to 36 mos......           0        7-14
 Alternatives for Children                            Agency or
 (CFDA 93.779).                                       Instrumentalit
                                                      y.
------------------------------
                                                            Research and Demonstration Grants
--------------------------------------------------------------------------------------------------------------------------------------------------------
4. Quality Assurance and       July 29, 2003.......  Any State                   1     500,000       360,000  Up to 36 mos......          10       12-30
 Quality Improvement in Home                          Agency or
 and Community-Based Services                         Instrumentalit
 (CFDA 93.779).                                       y.
5. Independence Plus           July 29, 2003.......  Any State                   1     500,000       360,000  Up to 36 mos......          20        8-16
 Initiative (CFDA 93.779).                            Agency or
                                                      Instrumentalit
                                                      y.
6. Money Follows the Person    July 29, 2003.......  Any State                   1     750,000       550,000  Up to 36 mos......          10       10-20
 Rebalancing Initiative (CFDA                         Agency or
 93.779).                                             Instrumentalit
                                                      y.
7. Community-                  July 29, 2003.......  Any State               \3\ 1     600,000       400,000  36 mos............          20        4-10
 IntegratedPersonal                                   Agency or
 Assistance Services and                              instrumentalit
 Supports (CFDA 93.779).                              y.
------------------------------
                                         Technical Assistance to States, State Advisory Committees and Families
--------------------------------------------------------------------------------------------------------------------------------------------------------
8. National State-to-State     July 29, 2003.......  Any Entity.....           N/A   4,400,000     4,400,000  36 mos............           0           1
 Technical Assistance Program
 for Community Living (CFDA
 93.779).
9. Technical Assistance for    July 29, 2003.......  Any consortium            N/A     550,000       550,000  36 mos............           0           1
 Consumer Task Forces (CFDA                           of consumer-
 93.779).                                             controlled
                                                      organizations
                                                      for people
                                                      with
                                                      disabilities
                                                      \4\.

[[Page 32526]]

 
10. Family-to-Family Health    July 29, 2003.......  Any Nonprofit               1     150,000       145,000  36 mos............           0       6-10
 Care Information and                                 Organization
 Education Centers (CFDA                              \5\.
 93.779).
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ The Single State Medicaid Agency or any other agency or instrumentality of a state (as determined under state law) may apply for any grant
  opportunity except the Technical Assistance for Consumer Task Forces 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.'' ``Territory or possession'' is defined as Guam, the United
  States Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. If an application is from an applicant that is not the
  Single State Medicaid Agency, a letter of endorsement from the Governor, State Medicaid Director, or Agency administering a relevant section of the
  1915(c) home and community-based waiver must accompany the application; this requirement does not apply to applicants for the National State-to-State
  Technical Assistance Program for Community Living, the Technical Assistance for Consumer Task Forces Grants, or the Family-to-Family Health Care
  Information and Education Centers Grants.
\2\ Direct Services do not include expenses budgeted for consumer task force member participation in Real Choice Systems Change for Community Living
  Conferences or technical assistance conferences sponsored by CMS or its national technical assistance providers for purposes of Real Choice Systems
  Change Grants for Community Living.
\3\ For the Community-Integrated Personal Assistance Services and Supports Grants (C-PASS), states that received a C-PASS grant in FY 2001 or FY 2002
  are ineligible to apply for FY 2003 C-PASS funding. FY 2001 C-PASS Grantees are: Alaska, Arkansas, Guam, Michigan, Minnesota, Montana, Nevada, New
  Hampshire, Oklahoma, and Rhode Island. FY 2002 C-PASS Grantees are: Colorado, District of Columbia, Hawaii, Indiana, Kansas, North Carolina,
  Tennessee, and West Virginia. Only states that did not receive a C-PASS grant in either FY 2001 or FY 2002 are eligible to apply.
\4\ Consumer-controlled organization means an organization that is governed by individuals who have a disability or long-term illness. Individuals of
  any age, who rely upon long-term supports and services as a result of a disability or long-term illness, must represent more than half of such
  organization's Board of Directors or other controlling structure.
\5\ Applicants for this type of grant must also have a letter of endorsement from the State Medicaid Director or the Governor or. In addition, states
  that currently operate Family-to-Family Family Health Care Information and Education Centers (funded through the Health Resources and Services
  Administration) are ineligible for funding under this initiative. Information and Education Centers application.

[FR Doc. 03-13582 Filed 5-27-03; 3:27 pm]
BILLING CODE 4120-03-P