[Federal Register Volume 68, Number 118 (Thursday, June 19, 2003)]
[Notices]
[Pages 36823-36827]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-15507]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Elder Health Care Initiative

AGENCY: Indian Health Service, HHS.

ACTION: Notice of availability of funds for competitive grants for 
development of long-term care infrastructure for American Indian and 
Alaska Native (AI/AN) elders.

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SUMMARY: The Indian Health Service (IHS) announces the availability of 
approximately $650,000 for competitive grants established under the 
authority of section 301(a) of the Public Health Service Act, as 
amended, to Tribal, Urban and non-profit Indian organizations to 
support projects that target the development of reimbursable long-term 
care services for American Indian and Alaska Native elders. There will 
be only one funding cycle during Fiscal Year (FY) 2003 (see Fund 
Availability and Period of Support). This program is described at 
93.933 in the Catalog of Federal Domestic Assistance. Executive Order 
12372 requiring intergovernmental review is not applicable to this 
program.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2010. A copy may be obtained by calling the National Center for Health 
Statistics, telephone (301) 443-8500 or at http://www.healthypeople.gov/document.
    Smoke Free Workplace: The PHS strongly encourages all grant 
recipients to provide a smoke-free workplace and promote the non-use of 
all tobacco products. This is consistent with the PHS mission to 
protect and advance the physical and mental health of the American 
people.
    Due Date: An original and two (2) copies of the completed grant 
application must be submitted with all required documentation to the 
Grants Management Branch, IHS, 801 Thompson Avenue, Suite 120, 
Rockville, MD 20852, by close of business August 1, 2003.
    Applications shall be considered as meeting the deadline if they 
are either: (1) Received on or before the deadline with hand carried 
applications received by close of business 5 p.m.; or (2) postmarked on 
or before the deadline date and received in time to be reviewed along 
with all other timely applications. A legibly dated receipt from a 
commercial carrier or the U.S. Postal Service will be accepted as proof 
of timely mailing. Private metered postmarks will not be accepted as 
proof of timely mailing. Applications received after the announced 
closing date will be returned to the applicant and will not be 
considered for funding.
    Additional Dates:
    A. Application Review Date: August 11--September 2, 2003.
    B. Applicants Notified of Results (approved, approved unfunded, or 
disapproved): September 15, 2003.
    C. Anticipated Start Date: September 15, 2003.
    Contacts for Assistance: For program information, contact Bruce 
Finke; M.D., Coordinator, IHS Elder Care Initiative, PO Box 467, Zuni, 
NM 87327, (505) 782-7357, [email protected].
    Techinical Assistance for applicants will be available from the 
NICOA Long Term Care Technical Support Center (Dave Baldridge, Program 
Director, (505) 292-2001 or [email protected]).
    For grant application and business information, contact Martha 
Redhouse, Grants Management Officer, Grants Management Branch, IHS, 801 
Thompson Avenue, Suite 120, Rockville, MD 20852, (301) 443-5204. (The 
telephone numbers are not toll-free numbers.)

SUPPLEMENTARY INFORMATION: This announcement provides information on 
the general program goal, eligibility and documentation requirements, 
programmatic activities, funding availability and period of support, 
and application procedures.
    General Program Goals: The American Indian and Alaska Native elder 
population is rapidly growing and the AI/AN population as a whole is 
aging. The prevalence of chronic disease in this population continues 
to increase, contributing to a frail elder population with increasing 
long-term care needs.
    The goal of this grant program is to assist Tribes and urban 
communities to develop reimbursable or self-financing long-term care 
services for their frail elders. The need for these services should be 
clearly established based on demographics and the assessment of rates 
of functional impairment in the population. The services should be 
acceptable to elders and their families and consistent with community 
values in their implementation. The services should be part of an 
overall vision and plan for a long-term care system to support elders 
and their families.
    Long-term care can be understood as an array of social and health 
care services that support an individual who has needs for assistance 
in activities of daily living over a prolonged period. While families 
continue to be the backbone of long-term care for AI/AN

[[Page 36824]]

elders, there is an urgent need to develop both services and systems of 
care to support families as they care for their elders. The way systems 
are developed and implemented can have significant impact on the 
cultural and spiritual health of the community. Home and community 
based services have been demonstrated to be the most cost efficient 
approach to long-term care, have the potential for meeting the needs of 
the vast majority of elders requiring long-term care services, and 
support the key roles of the family in the care of the elders and the 
elder in the care of the family and community.
    Tribes and communities have very different histories, capabilities, 
and resources with regard to long-term care program development. Thus, 
each tribe or community will have different priorities in building an 
infrastructure of long term care. The focus of long term care planning 
and service delivery is at the tribal and urban community level. An 
efficient and effective system of long term care would make use of all 
available resources, integrating and coordinating services to assist 
families in the care of their elders. A necessary step in that process 
is to develop tribally administered and delivered long term care 
services.
    Applicants are required to demonstrate the sustainability through 
ongoing reimbursement or other funding of projects initiated with grant 
funds. Applicants are also required to demonstrate how the grant-funded 
program integrates into a long-term care for the Tribe and community. A 
variety of resources are available to fund Tribal or urban AI/AN long-
term care services. While currently funded IHS services comprise parts 
of a long-term care system, the degree to which these resources are 
applied to the needs of elders depends both on the local health care 
priorities and on the degree of organization of the system to care for 
elders. Programs funded through the Administration on Aging (including 
the recently funded National Family Caregiver Support Program) have 
been key elements in the long-term care infrastructure in Indian 
communities. Other resources are available to provide long-term care 
services on a reimbursable basis to eligible AI/AN elders. The majority 
of long-term care services in this country are funded by Medicaid, 
Medicare (limited) and various State-home and community-based care 
programs. The Veterans Administration is also a source of reimbursement 
for long-term care services for eligible AI/AN Veterans. Federal 
housing programs are a potential resource in developing the long-term 
care infrastructures. Each of these resources has unique eligibility 
requirements.
    The Long-Term Care Technical Support Center (Dave Baldridge, 
Program Director, (505) 292-2001 or [email protected]) will be available 
to provide consultation and technical support to Tribes and communities 
as they develop their grant application.
    Eligibility and Documentation Requirements: Any federally 
recognized Indian Tribe, Tribal or American Indian/Alaska Native 
organization or 501(c)(3) non-profit organizations serving primarily 
American Indians and Alaska Natives is eligible to apply for a grant 
from the IHS under this announcement. All eligible Tribes, Tribal, or 
American Indian/Alaska Native organizations must meet the descriptions 
and criteria established to determine non-profit status as specified in 
this grant announcement. American Indian and Alaska Native Faith-Based 
non-profit organizations are both included and encouraged to apply as 
implied in American Indian/Alaska Native organizations as referenced 
above.

Documentation of Support

    1. Tribal Resolutions.
    (a) A resolution of the Indian Tribe or Indian Tribal organization 
supporting this specific project must accompany the application 
submission.
    (b) Applications which propose services which will benefit more 
than one Indian Tribe must include resolutions from all affected Tribes 
to be served.
    (c) Applications by Tribal organizations will not require 
resolution(s) if the current Tribal resolution(s) under which they 
operate would encompass the proposed grant activities. A statement of 
proof or a copy of the current operational resolution must accompany 
the application.
    (d) If a resolution or a statement is not submitted, the 
application will be considered incomplete and will be returned without 
consideration.
    2. Non-Profit organizations must submit a copy of the 501(c)(3) 
certificate, a valid IRS tax exemption certificate or a statement from 
a State taxing body certifying applicant organization has a nonprofit 
status.
    3. Letters of Cooperation/Collaboration/Assistance.
    (a) Letters included in the application should be specific to this 
program.
    (b) If other related human services programs are to be involved in 
the project, letters confirming the nature and extent of their 
cooperation/collaboration/assistance must be submitted.

Project Types

    Eligible projects are those that aim to develop the capacity to 
deliver long-term care services at the Tribal or regional level. The 
application should describe a comprehensive plan or vision for elder 
care services for the community and how the grant proposal will move 
toward that vision through program development. Examples include the 
establishment of a personal care agency licensed through a state home 
and community based care waiver program, establishment of hospice or 
home health agency, licensed elder day program, geriatric assessment 
(to identify the needs of the frail elder and their family and identify 
services which are currently available to meet those needs), case 
management to organize, broker, and monitor services, community housing 
such as assisted living, board and care or adult foster home.
    The proposal should:
    1. Include a brief assessment of current resources and programs.
    2. Demonstrate how the need for the particular service or program 
was identified. If information is not currently available regarding 
elder demographics and functional impairment rates, this should be 
obtained in the first year of the grant. Additional years of funding 
will be contingent on demonstrating this basic demographic information.
    3. Show how the project will make use of available funding streams 
(Medicaid waivers, personal care options or State-home and community 
based care services, VA long-term care benefits, other resources) for 
service delivery.
    4. Integrate or coordinate with currently available local services 
for the elderly (including those available through current IHS funding, 
Title VI or Family Caregiver Support funding, Tribal funding, and other 
resources). When possible this should be indicated in letters of 
support.
    5. Demonstrate consistency with cultural values of the community 
around the care of the elderly.
    6. Build upon the family as the primary source of support for the 
elder.
    7. Applicants are encouraged to explore novel funding streams to 
provide services (e.g., TANF training funds, HUD, USDA programs).
    8. The application should include a clear plan for self-sufficiency 
through reimbursement or ongoing funding by the end of the grant cycle. 
This should

[[Page 36825]]

include agency licensing or certification as required.
    9. Tribal match or cost sharing is not required.
    Fund Availability and Period of Support: In FY 2003, it is 
anticipated that approximately $650,000 will be available to support 20 
projects at approximately $30,000 to $50,000 each year for three years, 
inclusive of direct and indirect costs. Projects will be funded in 
annual budget periods of three years. Continuation of projects 
following the initial three-year project will be based upon the 
availability of appropriations in future years, the continuing need of 
IHS for the projects, and satisfactory project performance. Projects 
should not anticipate continued funding past the project period and 
should include efforts to become self-sustaining. The anticipated start 
date will be September 15, 2003.
    The Elder Care Initiative Grant Application Kit: An IHS Grant 
Application Kit, including form PHS 5161-1 (rev. 7.00), (OMB Approval 
No. 0920-0428) may be obtained from the Grants Management Branch, IHS, 
801 Thompson Avenue, Suite 120, Rockville, MD 20852, telephone (301) 
443-5204.

Factors for Consideration in Preparing the Application

    1. Following the outline provided in the announcement will guide 
the writing of the application and facilitate the reviewers in locating 
required information.
    2. Projects should demonstrate coordination with other agencies and 
organizations within and without the community who serve the targeted 
population.
    3. Indian cultural aspects should be considered in program design.
    Application Process: All applications must be single-spaced, 
typewritten, and consecutively numbered pages using black type not 
smaller than 12 characters per one inch, with conventional one-inch 
border margins, on only one side of standard size 8\1/2\ x 11 paper 
that can be photocopied. The application Narrative (not including the 
Appendix) must not exceed ten typed pages. An additional page may be 
used for each additional year of funding requested. Exclusions from the 
10-page limit are the Abstract, Tribal Resolution(s), 501(c)(3) non-
profit certificate, valid IRS tax exemption certificate, Letters of 
Documentation or Support, Standard Forms, Table of Contents, and the 
Appendix. All applications must include the following in the order 
presented:

(a) Tribal Resolution(s) and Documentation or 501(c)(3) Certification, 
or a copy of the Letters of Cooperation/Collaboration/Assistance
(b) Standard Form 424, Application for Federal Assistance
(c) Standard Form 424A, Budget Information--Non-Construction Programs 
(pages 1 and 2)
(d) Standard Form 424B, Assurances--Non-Construction Programs (front 
and back)
(e) Checklist (pages 25-26) NOTE: Each standard form and the checklist 
is contained in the PHS Grant Application, Form PHS 5161-1 (Rev. 07/00)
(f) A Project Abstract (may not exceed one typewritten page) should 
present a summary view of ``who-what-when-where-how-cost'' to determine 
acceptability for review
(g) A table of contents to correspond with numbered pages
(h) Project Narrative (10 pages)
    (1) Introduction and Need for Assistance
    (2) Project Objective(s), Approach, and Results & Benefits
    (3) Project Evaluation
    (4) Organizational Capabilities and Qualifications
    (5) Budget
(i) Proof of Non-Profit status as follows:
    1. A reference to the applicant organization's listing in the 
Internal Revenue Services: (IRS) most recent list of tax-exempt 
organizations described in section (501)(c)(3) of the IRS code.
    2. A copy of a currently valid IRS tax exemption certificate.
    3. A statement from a State taxing body, State Attorney General, or 
other appropriate State official certifying that the applicant 
organization has a non-profit status and that none of the net earnings 
accrue to any private shareholders or individuals.
    4. A certified copy of the organization's certificate of 
incorporation or similar document that clearly establishes non-profit 
status.
    5. Any of the above proof for a State or national parent 
organization and a statement signed by the parent organization that the 
applicant organization is a local non-profit affiliate.

(j) Appendix to include:
    (1) Resumes of key staff
    (2) Position description for key staff
    (3) Organizational chart
    (4) Documentation of current certified financial management systems
    (5) Copy of current negotiated indirect cost rate agreement
    (6) A map of the area to benefit from the project, and
    (7) Application Receipt Card, IHS-815-1A (Rev. 4-97).
(a) Narrative
    The narrative section of the application must include the 
following: (1) Justification for need for assistance; (2) work plan 
(including use of appropriate Native healing practices), program 
objectives, approach, expected results and evaluation process, (3) 
adequacy of management controls, and (4) key personnel. The work plan 
section should be project specific. These instructions for the 
preparation of the narrative are to be used in lieu of the instructions 
on pages 21-23 of PHS 5161-1. The narrative section should be written 
in a manner that is clear to outside reviewers unfamiliar with prior 
related activities of the applicant. It should be well organized, 
succinct, and contain all information necessary for reviewers to 
understand the project fully. The Narrative may not exceed TEN single 
spaced pages in length, excluding attachments, budget and Tribal 
Resolutions, 5019c)(3) non-profit certificate, and Letters of Support. 
(Pages must be numbered.
(b) Need for Assistance
    (1) Describe and define the target population at the project 
location (e.g. tribal population, number of elders 55 years and older, 
percentage and numbers of elders who have functional impairment and are 
in need of assistance). Information sources must be appropriately 
identified.
    (2) Describe the existing resources and services available, 
including the maintenance of Native healing systems, where appropriate, 
which are related to the specific program/service the applicant is 
proposing to provide. Supply the name, address, and phone number of a 
contact person for each.
    (3) Describe in detail the needs of the target population and what 
efforts have been made in the past to meet these needs, if any (e.g. 
programs and services currently available to meet the needs of the 
frail or functionally impaired elderly).
    (4) Summarize the applicable national, IHS, and/or State standards, 
laws and regulations, and describe the unmet needs of any applicant's 
current program in relation to applicable national, IHS, and/or State 
standards, laws and regulations, (e.g. Medicare/Medicaid, third-party 
payor reimbursements, Federal/State/Tribal

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laws regarding instituting home health agencies, elder housing, adult 
day-care, nursing homes, etc.)
(c) Work Plan
    (1) Program Objectives
    (i) State concisely the objectives of the project.
    (ii) Describe briefly what the project intends to accomplish.
    (iii) Describe how accomplishment of the objectives will be 
measured (including if replicable).
    (2) Approach
    (i) Describe the tasks and resources needed to implement and 
complete this project.
    (ii) Provide a task time line (milestones) breakdown or chart. 
Include the date that the project will begin to accept clients.
    (3) Describe the Expected Results
    (i) Discuss data collection for the project, how it will be 
obtained, analyzed, and maintained by the project. Data should include, 
but is not limited to, the number and types of clients served, services 
provided, client outcomes and satisfaction, and costs associated with 
the program.
    (ii) Describe how the data collection will support the stated 
program objectives and how it will support the program evaluation to 
determine the impact of the project.
    (4) Program Evaluation
    (i) Describe the methods for evaluating program activities, 
effectiveness of interventions, success in achieving objectives, the 
impact of interventions, acceptance among the targeted population, and 
workload accomplishments.
    (ii) Identify who will conduct the evaluation of the projected 
outcomes and when the evaluation is to be completed.
    (iii) Identify the cost of the evaluation (whether internal or 
external).
    (5) Program Continuance
    Discuss how the program services will be sustainable through 
ongoing reimbursement or other established funding mechanisms.
    (6) Experience Sharing
    Indicate the project's willingness to share its program experience 
with IHS Areas, urban programs, Tribes and other Tribal organizations.
(d) Adequacy of Management Controls
    (1) Describe where the project will be housed, i.e. facilities and 
equipment available.
    (2) Describe the management controls of the grantee over the 
directions and acceptability of work to be performed. Discuss personnel 
and financial systems in use and changes planned for this grant.
    (3) Applicant must demonstrate that the organization has adequate 
systems and expertise to manage Federal funds. Also, include a letter 
from the accounting firm describing results of the most recent 
organization-wide audit.
(e) Key Personnel
    (1) Provide a biographical sketch (qualifications) and position 
descriptions for the program director and other key personnel as 
described on page 22 of the PHS 5161-1. Identify existing personnel and 
new program staff to be hired.
    (2) Provide an organizational chart and indicate how the project 
will operate within the organization. Describe how this program will 
interface with other existing available resources.
    (3) List the qualifications and experience of consultants or 
contractors where their use is anticipated. Identify who will determine 
if the work of a contractor is acceptable.
(f) Budget
    (1) An itemized estimate of costs and justification for the 
proposed program by line item must be provided on Form SF 424A Budget 
Information Non-Construction Programs.
    (2) A narrative justification must be submitted for all costs. 
Indicate needs by listing individual items and quantities necessary. 
The need for items and quantities should be clearly specified in the 
narrative justification.
    (3) Any special start up costs should be indicated.
    (4) Three-Year Projects--Projects requiring three years of funding 
must include a brief program narrative and budget for each additional 
year of funding requested. The applicant may use one additional page to 
describe the developmental plans for each additional year of the 
project.
    (5) Grant funding may not be used to supplant existing public and 
private resources.
(g) Assurances
    The application shall contain assurance to the Secretary that the 
applicant will comply with program regulations, 42 CFR part 36, Subpart 
H.
    Review Process: Applications meeting eligibility requirements that 
are complete, responsive, and conform to this program announcement will 
be reviewed for merit by reviewers appointed by the IHS. The review 
will be conducted in accordance with PHS review procedures. The review 
process ensures selection of quality projects in a national competition 
for limiting funding. Applications will be evaluated and rated on the 
basis of the evaluation criteria listed below. These criteria are used 
to evaluate the quality of a proposed project, to assign a numerical 
score to each application, and to determine the likelihood of its 
success. Applications scoring below 60 points will not be funded. 
Applications that are acceptable for funding based on scoring will be 
ranked. Considerations in ranking include geographic diversity among 
funded programs, diversity in population size among Tribes and 
communities served by funded programs, and unique features with regard 
to type of program planned or population served.
    Evaluation Criteria: Applications will be evaluated against the 
following criteria and weights:

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     Weight       Criteria                   Description
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25%............          1  Need--The demonstration of identified
                             problems and risks in the target
                             population. Extent of community involvement
                             and commitment. This includes the statement
                             of the vision or plan for elder care and
                             the assessment of current resources,
                             programs, and existing funding streams for
                             services.
40%............          2  Work Plan--The soundness and effectiveness
                             of the applicant's plan for conducting the
                             project, with special emphasis on the
                             objectives and methodology portion of the
                             application. This includes how the proposal
                             fits the overall plan for long-term care,
                             how it will make use of existing or novel
                             funding streams for services, how it is
                             integrated into the existing service
                             structure, and the likelihood of achieving
                             self-sufficiency by the end of the grant
                             cycle.
15%............          3  Adequacy of Management Controls--The
                             apparent capability of the applicant to
                             successfully conduct the project including
                             both technical and business aspects. The
                             soundness of the applicant's budget in
                             relation to the project work plan and for
                             assuring effective utilization of grant
                             funds. Adequacy of facilities and equipment
                             available within the organization or
                             proposed for purchase under the project.
10%............          4  Key Personnel--Qualifications and adequacy
                             of the key staff.

[[Page 36827]]

 
10%............          5  Budget--Clarity and accuracy of program
                             costs, and cost justification for the
                             entire grant period.
100% Total Weight
------------------------------------------------------------------------

Reporting Requirements

    (1) Progress Report--Program progress reports will be required 
semiannually. These reports will include a brief description of a 
comparison of actual accomplishments to the goals established for the 
period, reasons for slippage and other pertinent information as 
required. A final report is due 90 days after expiration of the 
project/budget period.
    (2) Financial Status Report--A semiannual financial status report 
will be submitted 30 days after the end of the half-year. Final 
financial status reports are due 90 days after expiration of the 
project/budget period. Standard Form 269 (long form) will be used for 
financial reporting.
    Grant Administration Requirements: Grants are administered in 
accordance with the following documents:
    (1) 45 CFR Part 92. Department of Health and Human Services, 
Uniform Administrative Requirements for Grants and Cooperative 
Agreements to State and Local Governments, or 45 CFR Part 74, 
Administration of Grants to Non-profit recipients.
    (2) Public Health Service Grants Policy Statement, and
    (3) Appropriate Cost Principles: OMB Circular A-87, State and Local 
Governments, or OMB Circular A-122, Nonprofit Organizations.
    Results of the Review: Successful applicants are notified through 
the official Notice of Grant Award (NGA) document. The NGA will state 
the amount of Federal funds awarded, the purpose of the grant, the 
terms and conditions of the grant award, the effective date of the 
award, the project period, and the budget period.

    Dated: June 12, 2003.
Charles W. Grim,
Assistant Surgeon General, Interim Director, Indian Health Service.
[FR Doc. 03-15507 Filed 6-18-03; 8:45 am]
BILLING CODE 4160-16-M