[Federal Register Volume 68, Number 106 (Tuesday, June 3, 2003)]
[Notices]
[Pages 33167-33168]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-13758]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

[Announcement Number: HRSA-03-094]


Medicare Rural Hospital Flexibility Program Evaluation 
Cooperative Agreement

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces the availability of up to $1 million in fiscal year 2003 to 
fund a single competitive cooperative agreement to support the 
continuing evaluation of the Medicare Rural Hospital Flexibility grant 
program (Flex). The evaluation project will continue to assess the 
effectiveness of implementing the grant program in States and in rural 
communities and to provide recommendations for increasing the impact of 
the program to improve healthcare in rural America. Public and private 
entities possessing appropriate qualifications are eligible to apply. 
Faith based organizations are eligible to apply for these funds. 
Applications must be postmarked on or before June 30, 2003, to be 
considered. The award will be for a period of five years; continuation 
funding of up to $1 million annually in succeeding years is contingent 
upon availability of funds and grantee performance.
    Name of Grant Program: Medicare Rural Hospital Flexibility Program 
Evaluation (MRHFPE), Catalog of Federal Domestic Assistance (CFDA) 
number 93.241.
    Program Authorization: In 1997, section 1820 of the Social Security 
Act authorized the Medicare Rural Hospital Flexibility program. 
Reauthorization is pending. The appropriation for this program is 
provided in Public Law 108-7 (Consolidated Appropriations Resolution, 
2003).
    Submitting Applications: To receive a complete application kit, 
applicants may telephone the HRSA Grants Application Center at 1-877-
477-2123 beginning June 4, 2003. This program uses the standard form 
PHS 5161-1 (revised 7/00) for applications (approved under OMB number 
0920-0428). Applications must be received by 4 p.m. eastern time on 
July 3, 2003. An original and two copies must be submitted to the HRSA 
Grants Applications Center (GAC), 901 Russell Avenue, Suite 450, 
Gaithersburg, MD 20879, telephone 1-877-477-2123, e-mail 
[email protected]. Applicants will be notified through the same channels 
that currently announce the availability of downloadable and paper 
application materials, including notices on HRSA Web sites and e-mail 
communications. HRSA anticipates our first on-line grant applications 
will be available later in 2003. On-line submission of applications 
will be encouraged at that time; hard copy applications will still be 
accepted.

SUPPLEMENTARY INFORMATION: For the 65 million people living in rural 
America, the U.S. Department of Health and Human Services' mission to 
protect health and to provide assistance for those in need is 
especially relevant. Healthcare in rural communities supports 
communities' well-being and represents a significant segment of the 
local economies. These programs, however, frequently lack adequate 
funds, personnel and support networks.
    For more than a decade, the Office of Rural Health Policy (ORHP) 
has supported activities that assist States, localities and rural 
citizens as they work to build and sustain high-quality rural health 
care delivery systems. The Flex program provides funds to States to 
develop State rural health plans, support conversion of eligible small 
rural hospital facilities to critical access status (see Medicare 
conditions of participation for critical access hospitals), support 
rural EMS, and foster rural health care network development. This 
combination of activities is managed by each State in a manner that 
meets program objectives and is simultaneously most appropriate for the 
individual State. Taken as a whole, the purpose of the program is to 
improve access to care and quality of care by strengthening and 
integrating rural health care delivery systems while improving small 
hospital finances through providing cost based reimbursement.
    Evaluation of the Flex program during its first four operational 
years has produced an important body of knowledge about rural health 
care, rural hospitals, financial issues, network development, EMS 
integration and community engagement in rural health care decision-
making. This work has been performed by a consortium of six Centers: 
Southern Maine University, University of Minnesota, University of North 
Carolina Sheps Center, University of Nebraska (Rural Policy Research 
Institute), University of Washington and the Walsh Center of Project 
Hope. Information resulting from the evaluation is publicly available. 
As the program matures, the evaluation process will focus less on the 
process of converting hospitals to critical access status and more on 
development of rural organized systems of care, financial performance, 
impact on access to and quality of care, disease management, community 
role, and impact on health status of rural populations served by these 
emerging systems. Improving clinical, financial and leadership 
performance of rural healthcare organizations, access to capital and 
progress in acquisition and use of technology will be important areas 
of evaluation. Development of appropriate performance measures and 
documenting the impact of this program will provide enormous value to 
rural Americans.
    Purpose: The purpose of this cooperative agreement is to measure 
and evaluate the effectiveness of implementation of the Flex program 
both nationally and at the level of the State, to make the information 
thus obtained publicly available, and to make recommendations for 
improving program effectiveness at all levels. Specifically, through 
this cooperative agreement, the grantee will:
    [sbull] Design and implement appropriate mechanisms for the next 
phase of evaluation and dissemination;

[[Page 33168]]

    [sbull] Maintain and disseminate data and information to public 
entities and the rural healthcare community;
    [sbull] Design and apply a logic model to evaluate the 
effectiveness of State grantees in using Federal funds to improve rural 
healthcare in their State, achieve program objectives and perform 
Statewide planning and evaluation processes;
    [sbull] Measure changes in quality, network development, EMS, 
utilization and community participation resulting from the Flex 
program;
    [sbull] Collaborate with other entities in the evaluation process 
for discrete components and projects;
    [sbull] Assess the impact of Flex upon the access to care and 
health status of rural populations served through Flex supported 
provider systems;
    [sbull] Document the impact on clinical quality, financial 
performance and leadership of rural providers served through Flex.
    This cooperative agreement involves substantial ORHP policy 
expertise and programmatic involvement with the awardee. Under the 
terms of this cooperative agreement in addition to the required 
monitoring and technical assistance, Federal responsibilities will 
include:
    (1) Participation in annual project meetings conducted during the 
period of the agreement;
    (2) Ongoing review of evaluation activities and procedures;
    (3) Review of project information prior to public dissemination;
    (4) Participation in design of evaluation process;
    (5) Shared decision-making on collaborators and their projects;
    (6) Assistance with the establishment of contacts with Federal and 
State agencies, grant projects and other contacts that may be relevant 
to the project's mission.
    Eligibility: Any public or private entity is eligible to apply. 
Under the President's initiative, community-based and faith based 
organizations that are otherwise eligible and believe they can 
contribute to HRSA's program objectives are encouraged to consider this 
initiative. There is no requirement for matching funds with this 
program.
    Review criteria: Applications that are complete and responsive to 
the guidance will be evaluated by an objective review panel 
specifically convened for this solicitation in accordance with HRSA 
grants management policies and procedures. Preference will be given to 
applicants who have participated in the first four years of the 
evaluation project. This means that applications carrying the 
preference and recommended for approval by the panel will be considered 
ahead of applications without the preference.
    Applications will be reviewed using the following criteria:
    [sbull] Demonstrated knowledge and understanding of relevant issues 
(30%) including the Medicare rural hospital flexibility program, rural 
healthcare networking, rural health care quality, performance of rural 
healthcare organizations, and rural organized systems of care.
    [sbull] Merits of the proposal (20%) including: (1) Degree to which 
the application responds to grant guidance and project vision, 6%; (2) 
quality and feasibility of the design and implementation proposal, 5%; 
(3) understanding of collaborative relationships between the project 
officer and the grantee, 3%; and (4) clear and comprehensible 
presentation of budget with tight connection to project objectives, 
activities and required resources, 6%.
    [sbull] Applicant capability, capacity and relevant experience 
(40%) including prior experience with and relevant knowledge of the 
Medicare Rural Hospital Flexibility program, prior experience in 
program evaluation, established working relationships with potential 
collaborators with relevant experience and strong capabilities, 
adequacy of staff, facilities and technology, and commitment and 
demonstrated ability to manage projects and adhere to agreed timelines 
and delivery schedules.
    [sbull] Appropriateness of budget (10%) including maximization of 
the proportion of funds devoted to program objectives, the extent to 
which the proposed budget is realistic, adequately justified and 
consistent with the proposed project plan, and the degree to which the 
costs of the proposed project are economical in relation to the 
proposed activities.
    Additional criteria may be used in the review of applications for 
this competition. Any such criteria will be identified in the program 
guidance included in the application kit. Applicants should pay strict 
attention to addressing these criteria in addition to those referenced 
above.
    Program Contact Person: Forrest Calico, M.D., M.P.H., Office of 
Rural Health Policy, HRSA, Rm. 9A-55, Parklawn Bldg., 5600 Fishers 
Lane, Rockville, MD 20857. Phone (301) 443-0835, Fax (301) 443-2803, e-
mail [email protected].
    Paperwork Reduction Act: OMB approval for any data collection in 
connection with this corporate agreement will be sought, as required 
under the Paperwork Reduction Act of 1995.
    This program is subject to the provisions of executive order 12372 
concerning intergovernmental review of Federal programs by appropriate 
health planning agencies, as implemented by 45 CFR part 100. Executive 
Order 12372 allows States the option of setting up a system for 
reviewing applications from within their States for assistance under 
certain Federal programs. Please visit the Web site http://www.whitehouse.gov/omb/grants/spoc.html for a listing of these States. 
The application packages to be made available under this notice will 
contain a listing of States which have chosen to set up such a review 
system and will provide a single point of contact (SPOC) in the States 
for review. Applicants (other than federally-recognized Indian tribal 
governments) should contact their State SPOCs as early as possible to 
alert them to the prospective applications and receive any necessary 
instructions on the State process. For proposed projects serving more 
than one State, the applicant is advised to contact the SPOC of each 
affected State. The due date for State process recommendations is 60 
days after the application deadline for new and competing awards. The 
granting agency does not guarantee to ``accommodate or explain'' for 
State process recommendations it receives after that date. (See part 
148, Intergovernmental Review of PHS Programs under Executive Order 
12372 and 45 CFR part 100 for a description of the review process and 
requirements). This program is not subject to the public health systems 
reporting requirements.

    Dated: May 8, 2003.
Elizabeth M. Duke,
Administrator.
[FR Doc. 03-13758 Filed 6-2-03; 8:45 am]
BILLING CODE 4165-15-P