[Federal Register Volume 81, Number 49 (Monday, March 14, 2016)]
[Notices]
[Pages 13380-13395]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-05761]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Office of Urban Indian Health Programs; 4-in-1 Grant Programs; 
Announcement Type: New and Competing Continuation Funding Announcement 
Number: HHS-2016-IHS-UIHP2-0001; Catalogue of Federal Domestic 
Assistance Number: 93.193

Key Dates

    Application Deadline Date: May 15, 2016.
    Review Period: May 23, 2016-May 27, 2016.
    Earliest Anticipated Start Date: June 1, 2016.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting competitive grant 
applications for the FY 2016 4-in-1 Title V Programs. This program is 
authorized under the Snyder Act, 25 U.S.C. 13, Public Law 67-85, and 
Title V of the Indian Health Care Improvement Act (IHCIA), Public Law 
94-437, as amended, specifically the provisions codified at 25 U.S.C. 
1652, 1653, and 1660a. This program is described in the Catalog of 
Federal

[[Page 13381]]

Domestic Assistance (CFDA) under 93.193.

Background

    Prior to the 1950's, most American Indians and Alaska Natives (AI/
ANs) resided on reservations, in nearby rural towns, or in Tribal 
jurisdictional areas such as Oklahoma. In the era of the 1950's and 
1960's, the Federal Government passed legislation to terminate its 
legal obligations to the Indian Tribes, resulting in policies and 
programs to assimilate Indian people into the mainstream of American 
society. This philosophy produced the Bureau of Indian Affairs (BIA) 
Relocation/Employment Assistance Programs (BIA Relocation) which 
enticed Indian families living on impoverished Indian Reservations to 
``relocate'' to various cities across the country, i.e., San Francisco, 
Los Angeles, Chicago, Salt Lake City, Phoenix, etc. BIA Relocation 
offered job training and placement, and was viewed by Indians as a way 
to escape poverty on the reservation. Health care was usually provided 
for six months through the private sector, unless the family was 
relocated to a city near a reservation with an IHS facility service 
area, such as Rapid City, Phoenix, and Albuquerque. Eligibility for IHS 
was not forfeited due to Federal Government relocation.
    The American Indian and Policy Review Commission found that in the 
1950's and 1960's, the BIA relocated over 160,000 AI/ANs to selected 
urban centers across the country. Today, over 61 percent of all AI/ANs 
identified in the 2010 census reside off-reservation.
    In the late 1960's, urban Indian community leaders began advocating 
at the local, State and Federal levels for culturally appropriate 
health programs addressing the unique social, cultural and health needs 
of AI/ANs residing in urban settings. These community-based grassroots 
efforts resulted in programs targeting health and outreach services to 
the urban Indian community. Programs that were developed at that time 
were in many cases staffed by volunteers, offering outreach and 
referral-type services, and maintaining programs in storefront settings 
with limited budgets and primary care services.
    In response to efforts of the urban Indian community leaders in the 
1960's, Congress appropriated funds in 1966, through the IHS, for a 
pilot urban clinic in Rapid City. In 1973, Congress appropriated funds 
to study the unmet urban Indian health needs in Minneapolis. The 
findings of this study documented cultural, economic, and access 
barriers to health care for urban Indian clinics in several BIA 
relocation cities, i.e., Seattle, San Francisco, Tulsa, and Dallas.
    The awareness of poor health status of all Indian people continued 
to grow, and in 1976, Congress passed the Indian Health Care 
Improvement Act (IHCIA), Public Law 94-437, establishing the urban 
Indian health program under Title V. Congress reauthorized the IHCIA in 
2010 under Public Law 111-148 (2010). This law is considered health 
care reform legislation to improve the health and well-being of all AI/
ANs, including urban Indians. Title V specific funding is authorized 
for the development of programs for AI/ANs residing in urban areas. 
Since passage of this legislation, amendments to Title V provided 
resources to and expanded urban Indian health programs in the areas of 
direct medical services, alcohol services, mental health services, 
human immunodeficiency virus (HIV) services, and health promotion--
disease prevention services.

Purpose

    This grant announcement seeks to ensure the highest possible health 
status for AI/ANs. Funding will be used to promote urban Indian 
organizations' successful implementation of the priorities of the IHS 
Strategic Plan 2006-2011. Additionally, funding will be utilized to 
meet objectives for Government Performance Results Act/Government 
Performance and Results Modernization Act (GPRA/GPRAMA) reporting, 
collaborative activities with the Veterans Health Administration, and 
four health programs that make health services more accessible to AI/
ANs living in urban areas. The four health services programs are: (1) 
Health Promotion/Disease Prevention (HP/DP) services, (2) 
Immunizations, and Behavioral Health Services consisting of (3) 
Alcohol/Substance Abuse services, and (4) Mental Health Prevention and 
Treatment services. These programs are integral components of the IHS 
improvement in patient care initiative and the strategic objectives 
focused on improving safety, quality, affordability, and accessibility 
of health care.

II. Award Information

Type of Awards

    Grants.

Estimated Funds Available

    The total amount of funding identified for the current fiscal year 
(FY) 2016 is approximately $8,300,000. Individual award amounts are 
anticipated to be between $149,950 and $634,222. The amount of funding 
available for competing and continuation awards issued under this 
announcement are subject to the availability of appropriations and 
budgetary priorities of the Agency. The IHS is under no obligation to 
make awards that are selected for funding under this announcement.

Anticipated Number of Awards

    Approximately 34 grants will be issued under this program 
announcement.

Project Period

    The project period is for three years and will run consecutively 
from April 1, 2016-March 31, 2019.

III. Eligibility Information

1. Eligibility

    To be eligible to apply for this New/Competing Continuation grant 
under this announcement, applicants must have a Title V IHCIA contract 
with the IHS in place as defined by 25 U.S.C. 1653(c)-(e), 1660a. Urban 
Indian organizations are defined by 25 U.S.C. 1603(29) as a non-profit 
corporate body situated in an urban center, governed by an urban Indian 
controlled board of directors, and providing for the maximum 
participation of all interested Indian groups and individuals, which 
body is capable of legally cooperating with other public and private 
entities for the purpose of performing the activities described in 25 
U.S.C. 1653(a).
    Current UIHP 4-in-1 grantees are eligible to apply for competing 
continuation funding under this announcement and must demonstrate that 
they have complied with previous terms and conditions of the UIHP 4-in-
1 grant in order to receive funding under this announcement. All prior 
4-in-1 awardees from the grant segment ending in FY 2015, are required 
to complete and submit their FY 2016 applications based on the funding 
amounts received in FY 2015.

    Note: Please refer to Section IV.2 (Application and Submission 
Information/Subsection 2, Content and Form of Application Submission) 
for additional proof of applicant status documents required such as 
Tribal resolutions, proof of non-profit status, etc.

2. Cost Sharing or Matching

    IHS does not require matching funds or cost sharing for grants or 
cooperative agreements.

3. Other Requirements

    If the application budget exceeds the highest dollar amount 
outlined under

[[Page 13382]]

the ``Estimated Funds Available'' section within this funding 
announcement, the application will be considered ineligible and will 
not be reviewed for further consideration. If deemed ineligible, IHS 
will not return the application. The applicant will be notified by 
email by the Division of Grants Management (DGM) of this decision.
Proof of Non-Profit Status
    Organizations claiming non-profit status must submit proof. A copy 
of the 501(c)(3) Certificate must be received with the application 
submission by the Application Deadline Date listed under the Key Dates 
section on page one of this announcement.
    An applicant submitting any of the above additional documentation 
after the initial application submission due date is required to ensure 
the information was received by the IHS by obtaining documentation 
confirming delivery (i.e. FedEx tracking, postal return receipt, etc.).

IV. Application and Submission Information

1. Obtaining Application Materials

    The application package and detailed instructions for this 
announcement can be found at Grants.gov (www.grants.gov) or http://www.ihs.gov/dgm/funding/.
    Questions regarding the electronic application process may be 
directed to Mr. Paul Gettys at (301) 443-2114 or (301) 443-5204.

2. Content and Form of Application Submission

    The application must include the project narrative as an attachment 
to the application package. Mandatory documents for all applications 
include:
     Table of contents.
     Abstract (one page) summarizing the key project 
information.
     Application forms:
    [cir] SF-424, Application for Federal Assistance.
    [cir] SF-424A, Budget Information--Non-Construction Programs.
    [cir] SF-424B, Assurances--Non-Construction Programs.
     Budget Justification and Narrative (must be single-spaced 
and not exceed five pages).
     Project Narrative (must be single-spaced and not exceed 
twenty-five pages).
    [cir] Background information on the organization.
    [cir] Proposed scope of work, objectives, and activities that 
provide a description of what will be accomplished, including a one-
page Timeframe Chart.
     501(c)(3) Certificate.
     Biographical sketches for all Key Personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL).
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost rate (IDC) 
agreement (required) in order to receive IDC.
     Organizational Chart (optional).
     Documentation of current Office of Management and Budget 
(OMB) A-133 or other required Financial Audit (if applicable).
    Acceptable forms of documentation include:
    [cir] Email confirmation from Federal Audit Clearinghouse (FAC) 
that audits were submitted; or
    [cir] Face sheets from audit reports. These can be found on the FAC 
Web site: http://harvester.census.gov/sac/dissem/accessoptions.html?submit=Go+To+Database.
Public Policy Requirements
    All Federal wide public policies apply to IHS grants with exception 
of the Discrimination policy.
Requirements for Project and Budget Narratives
    A. Project Narrative: The project narrative should be a separate 
Word document that is no longer than 25 pages and must: Be single-
spaced, be type-written, have consecutively numbered pages, use black 
type not smaller than 12 characters per one inch, and be printed on one 
side only of standard size 8\1/2\ x 11 paper.
    Be sure to succinctly address and answer all questions listed under 
the narrative and place them under the evaluation criteria (refer to 
Section V.1, Evaluation criteria in this announcement) and place all 
responses and required information in the correct section (noted 
below), or they shall not be considered or scored. These narratives 
will assist the Objective Review Committee (ORC) in becoming familiar 
with the applicant's activities and accomplishments prior to this grant 
award. If the narrative exceeds the page limit, only the first 25 pages 
will be reviewed. The 25-page limit for the narrative does not include 
the table of contents, abstract, standard forms, budget justification 
narrative, and/or other appendix items.
    There are three parts to the narrative: Part A--Program 
Information; Part B--Program Planning and Evaluation; and Part C--
Program Report. See below for additional details about what must be 
included in the narrative.
Part A: Program Information (3 Page Limitation)
Section 1: Needs
    Describe how the urban Indian organization has expertise and 
administrative infrastructure to support activities of the 4-in-1 grant 
requirements.
Part B: Program Planning and Evaluation (18 Page Limitation)
Section 1: Program Plans
    Describe fully and clearly how the urban Indian organization plans 
to address the four health service programs, including HP/DP, 
immunization, alcohol/substance abuse, and mental health.
Section 2: Program Evaluation
    Describe the urban Indian organization evaluation plan including 
how the applicant will link program performance/services to budget 
expenditures.
Part C: Program Report (4 Page Limitation)
Section 1: Describe Major Accomplishments for the Last Twelve Months
Section 2: Describe Major Activities Planned for the First 12 Months
    B. Budget Narrative: This narrative must include a line item budget 
with a narrative justification for all expenditures identifying 
reasonable and allowable costs necessary to accomplish the goals and 
objectives as outlined in the project narrative. Budget should match 
the scope of work described in the project narrative. The budget 
narrative should not exceed five pages.

3. Submission Dates and Times

    Applications must be submitted electronically through Grants.gov by 
11:59 p.m. Eastern Daylight Time (EDT) on the Application Deadline Date 
listed in the Key Dates section on page one of this announcement. Any 
application received after the application deadline will not be 
accepted for processing, nor will it be given further consideration for 
funding. Grants.gov will notify the applicant via email if the 
application is rejected.
    If technical challenges arise and assistance is required with the 
electronic application process, contact Grants.gov Customer Support via 
email to [email protected] or at (800) 518-4726. Customer Support is 
available to address questions 24 hours a day, 7 days a week (except on 
Federal holidays). If problems persist, contact Mr. Paul Gettys 
([email protected]), DGM

[[Page 13383]]

Grant Systems Coordinator, by telephone at (301) 443-2114 or (301) 443-
5204. Please be sure to contact Mr. Gettys at least ten days prior to 
the application deadline. Please do not contact the DGM until you have 
received a Grants.gov tracking number. In the event you are not able to 
obtain a tracking number, call the DGM as soon as possible.
    If the applicant needs to submit a paper application instead of 
submitting electronically through Grants.gov, a waiver must be 
requested. Prior approval must be requested and obtained from Mr. 
Robert Tarwater, Director, DGM (see Section IV.6 below for additional 
information). The waiver must: (1) Be documented in writing (emails are 
acceptable), before submitting a paper application, and (2) include 
clear justification for the need to deviate from the required 
electronic grants submission process. A written waiver request must be 
sent to [email protected] with a copy to [email protected]. 
Once the waiver request has been approved, the applicant will receive a 
confirmation of approved email containing submission instructions and 
the mailing address to submit the application. A copy of the written 
approval must be submitted along with the hardcopy of the application 
that is mailed to DGM. Paper applications that are submitted without a 
copy of the signed waiver from the Senior Policy Analyst of the DGM 
will not be reviewed or considered for funding. The applicant will be 
notified via email of this decision by the Grants Management Officer of 
the DGM. Paper applications must be received by the DGM no later than 
5:00 p.m., EDT, on the Application Deadline Date listed in the Key 
Dates section on page one of this announcement. Late applications will 
not be accepted for processing or considered for funding.

4. Intergovernmental Review

    Executive Order 12372 requiring intergovernmental review is not 
applicable to this program.

5. Funding Restrictions

     Pre-award costs are not allowed.
     The available funds are inclusive of direct and 
appropriate indirect costs.
     Only one grant/cooperative agreement will be awarded per 
applicant.
     IHS will not acknowledge receipt of applications.

6. Electronic Submission Requirements

    All applications must be submitted electronically. Please use the 
http://www.Grants.gov Web site to submit an application electronically 
and select the ``Find Grant Opportunities'' link on the homepage. 
Download a copy of the application package, complete it offline, and 
then upload and submit the completed application via the http://www.Grants.gov Web site. Electronic copies of the application may not 
be submitted as attachments to email messages addressed to IHS 
employees or offices.
    If the applicant receives a waiver to submit paper application 
documents, they must follow the rules and timelines that are noted 
below. The applicant must seek assistance at least ten days prior to 
the Application Deadline Date listed in the Key Dates section on page 
one of this announcement.
    Applicants that do not adhere to the timelines for System for Award 
Management (SAM) and/or http://www.Grants.gov registration or that fail 
to request timely assistance with technical issues will not be 
considered for a waiver to submit a paper application.
    Please be aware of the following:
     Please search for the application package in http://www.Grants.gov by entering the CFDA number of the Funding Opportunity 
Number. Both numbers are located in the header of this announcement.
     If you experience technical challenges while submitting 
your application electronically, please contact Grants.gov Support 
directly at: [email protected] or (800) 518-4726. Customer Support is 
available to address questions 24 hours a day, 7 days a week (except on 
Federal holidays).
     Upon contacting Grants.gov, obtain a tracking number as 
proof of contact. The tracking number is helpful is there are technical 
issues that cannot be resolved and a waiver from the agency must be 
obtained.
     If it is determined that a waiver is needed, the applicant 
must submit a request in writing (emails are acceptable) to 
[email protected] with a copy to [email protected]. Please 
include a clear justification for the need to deviate from the standard 
electronic submission process.
     If the waiver is approved, the application should be sent 
directly to the DGM by the Application Deadline Date listed in the Key 
Dates section on page one of this announcement.
     Applicants are strongly encouraged not to wait until the 
deadline date to begin the application process through Grants.gov as 
the registration process for SAM and Grants.gov could take up to 
fifteen working days.
     Please use the optional attachment feature in Grants.gov 
to attach additional documentation that may be requested by the DGM.
     All applicants must comply with any page limitation 
requirements described in this funding announcement.
     After electronically submitting the application, the 
applicant will receive an automatic acknowledgement from Grants.gov 
that contains a Grants.gov tracking number. The DGM will download the 
application from Grants.gov and provide necessary copies to the 
appropriate agency officials. Neither the DGM nor the Office of Urban 
Indian Health Programs will notify the applicant that the application 
has been received.
     Email applications will not be accepted under this 
announcement.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
    All IHS applicants and grantee organizations are required to obtain 
a DUNS number and maintain an active registration in the SAM database. 
The DUNS number is a unique 9-digit identification number provided by 
D&B which uniquely identifies each entity. The DUNS number is site 
specific; therefore, each distinct performance site may be assigned a 
DUNS number. Obtaining a DUNS number is easy, and there is no charge. 
To obtain a DUNS number, please access it through http://fedgov.dnb.com/webform, or to expedite the process, call (866) 705-
5711.
    All Department of Health and Human Services recipients are required 
by the Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), to report information on sub-awards. 
Accordingly, all IHS grantees must notify potential first-tier sub-
recipients that no entity may receive a first-tier sub-award unless the 
entity has provided its DUNS number to the prime grantee organization. 
This requirement ensures the use of a universal identifier to enhance 
the quality of information available to the public pursuant to the 
Transparency Act.
System for Award Management (SAM)
    Organizations that were not registered with Central Contractor 
Registration and have not registered with SAM will need to obtain a 
DUNS number first and then access the SAM online registration through 
the SAM home page at https://www.sam.gov (U.S. organizations will also 
need to provide an Employer Identification Number from the Internal 
Revenue Service that may take an additional 2-5 weeks to become 
active). Completing and

[[Page 13384]]

submitting the registration takes approximately one hour to complete 
and SAM registration will take 3-5 business days to process. 
Registration with the SAM is free of charge. Applicants may register 
online at https://www.sam.gov.
    Additional information on implementing the Transparency Act, 
including the specific requirements for DUNS and SAM, can be found on 
the IHS Grants Management, Grants Policy Web site: http://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    The instructions for preparing the application narrative also 
constitute the evaluation criteria for reviewing and scoring the 
application. Weights assigned to each section are noted in parentheses. 
The 25 page narrative should include only the first year activities; 
information for multi-year projects should be included as an appendix. 
See ``Multi-year Project Requirements'' at the end of this section for 
more information. The narrative 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. 
Points will be assigned to each evaluation criteria adding up to a 
total of 100 points. A minimum score of 60 points is required for 
funding. Points are assigned as follows:

1. Criteria

    The narrative should address program progress for the first 12 
months.
A. Introduction and Need for Assistance (30 Points)
1. Facility Capability
    Urban Indian programs provide health care services within the 
context of IHS Strategic Plan and four IHS priorities.
    Describe the UIHP: (1) Accomplishments over the past twelve months, 
and (2) define activities planned for the 2016 budget period in each of 
the following areas:
    a. IHS Priorities for American Indian/Alaska Native Health Care. 
Current governmental trends and environmental issues impact AI/ANs 
residing in urban locations and require clear and consistent support by 
the Title V funded UIHP. The IHS Web site is http://www.ihs.gov.
    (1) Renew and strengthen our partnerships with Tribes and urban 
Indian health programs: The UIHPs have a hybrid relationship with the 
IHS. With the passage of Pubic Law 111-148, the Indian Health Care 
Improvement Act was made permanent.
     Identify what the UIHP is doing to strengthen its 
partnerships with Tribes and other urban Indian health programs.
    a. Major accomplishments over the last twelve months.
    b. Activities planned for the first 12 months, including 
information on how results are shared with the community.
    (2) Improve the IHS: In order to support health care improvement, 
it must be demonstrated there is a willingness to change and improve, 
i.e., in human resources and business practices.
     Describe activities the UIHP is taking to ensure health 
care improvement is being applied.
    a. Major accomplishments over the last twelve months.
    b. Activities planned for the first 12 months.
    (3) Improve the quality of and access to care: Customer service is 
the key to quality care. Treating patients well is the first step to 
improving quality and access. This area also incorporates best 
practices in customer service.
     Identify activities that demonstrate the UIHP improving 
quality of and access to care.
    a. Major accomplishments over the last twelve months.
    b. Activities planned for the first 12 months.
    (4) Ensure that our work is transparent, accountable, fair, and 
inclusive: Quality health care needs to be transparent, with all 
parties held accountable for that care. Accountability for services is 
emphasized.
     Describe activities that demonstrate how this is 
implemented in the UIHP program.
    a. Major accomplishments over the last twelve months.
    b. Activities planned for the first 12 months.
b. GPRA Reporting
    All UIHPs report on IHS GPRA/GPRAMA clinical performance measures. 
This is required of both urban facilities using the Resource and 
Patient Management System (RPMS) and facilities not using RPMS. RPMS 
users must use the Clinical Reporting System (CRS) for reporting. Non-
RPMS users must perform a 100% audit of all records and report results 
on an Excel template provided by the National GPRA Support Team (NGST) 
as per the quarterly reporting instructions distributed by the NGST. 
Questions related to GPRA reporting may be directed to the IHS Area 
Office GPRA Coordinator or the National GPRA Support Team at 
[email protected].
    The current GPRA Reporting Period is July 1, 2015 through June 30, 
2016. GPRA reports are due for the 2nd, 3rd, and 4th quarters, which 
end on December 31, March 31, and June 30, respectively. Each report is 
cumulative, and must include data starting from July 1st of the current 
GPRA year.
    GPRA measures to report for FY2016 include 20 clinical measures and 
one non-clinical measure.
FY 2016 Clinical GPRA/GPRAMA Measures
    1. Diabetes DX Ever (no target, used for context only).
    2. Documented A1c (no target, used for context only).
    3. Diabetes: Good Glycemic Control (GPRAMA measure).
    4. Diabetes: Controlled Blood Pressure.
    5. Diabetes: Statin Therapy to Reduce CVD Risk in Patients with 
Diabetes.
    6. Diabetes: Nephropathy Assessment.
    7. Influenza Vaccination Rates Among Children 6 months to 17 years.
    8. Influenza Vaccination Rates Among Adults 18+.
    9. Pneumococcal Immunization 65+.
    10. Childhood Immunizations (GPRAMA).
    11. Pap Screening Rates.
    12. Mammography Screening Rates.
    13. Colorectal Cancer Screening Rates.
    14. Tobacco Cessation.
    15. Alcohol Screening (FAS Prevention).
    16. Domestic Violence/Intimate Partner Violence Screening.
    17. Depression Screening (GPRAMA).
    18. HIV Screening.
    19. Breastfeeding Rates.
    20. Childhood Weight Control (long-term measures, result will be 
reported in FY2016).
FY 2016 NON CLINICAL GPRA/GPRAMA MEASURE
    1. Suicide Surveillance (RPMS Programs only).
    FY 2016 measure targets are attached. Note that since 2013, urban 
measure targets are the same as the targets for Tribal and Federal 
health programs.
    1. The following GPRAMA measures should be prioritized for target 
achievement: Good Glycemic Control, Childhood Immunizations and 
Depression Screening. Briefly describe the steps/activities you will 
take to ensure your program meets the FY 2016 target rates for these 
measures.
    2. Describe at least two actions you will complete to meet the FY 
2016 GPRA/GPRAMA performance targets. A Performance Improvement Toolbox 
with information on clinical GPRA measures, screening tools, and 
guidelines is

[[Page 13385]]

available on the CRS Web site at: http://www.ihs.gov/crs/toolbox/http://www.ihs.gov/crs/index.cfm?module=crs_performance_improvement_toolbox.
    3. GPRA Behavioral Health performance measures include Alcohol 
Screening (to prevent Fetal Alcohol Syndrome), Domestic (Intimate 
Partner) Violence Screening and Depression Screening (for adults over 
age 18). Describe actions you will take to improve 2015-2016 desired 
behavioral health performance outcomes/results.
    4. Document your ability to collect and report on the required 
performance measures to meet GPRA requirements. Include information 
about your health information technology system.
    c. Schedule of Charges and Maximization of Third Party Payments
    1. Describe the UIHP established schedule of charges and 
consistency with local prevailing rates.
     If the UIHP is not currently billing for billable 
services, describe the process the UIHP will take to begin third party 
billing to maximize collections.
    2. Describe how reimbursement is maximized from Medicare, Medicaid, 
State Children's Health Insurance Program, private insurance, etc.
    3. Describe how the UIHP achieves cost effectiveness in its billing 
operations with a brief description of the following:
    a. Establishes appropriate eligibility determination.
    b. Reviews/updates and implements up-to-date billing and collection 
practices.
    c. Updates insurance at every visit.
    d. Maintains procedures to evaluate necessity of services.
    e. Identifies and describes financial information systems used to 
track, analyze and report on the program's financial status by revenue 
generation, by source, aged accounts receivable, provider productivity, 
and encounters by payor category.
    f. Indicates the date the UIHP last reviewed and updated its 
Billing Policies and Procedures.
B. Program Narratives and Work Plans (40 Points)
    A program narrative and a program specific work plan are required 
for each health services program: (1) HD/DP, (2) Immunizations, (3) 
Alcohol/Substance Abuse, and (4) Mental Health. Title V of the IHCIA, 
Public Law 94-437, as amended, identifies eligibility for health 
services as follows.
    Each grantee shall provide health care services to eligible urban 
Indians living within the urban service area. An ``Urban Indian'' 
eligible for services, as codified at 25 U.S.C. 1603(13), (27), and 
(28), includes any individual who:
    1. Resides in an urban center, which is any community that has a 
sufficient urban Indian population with unmet health needs to warrant 
assistance under the IHCIA, as determined by the Secretary, HHS; and 
who
    2. Meets one or more of the following criteria:
    a. Irrespective of whether he or she lives on or near a 
reservation, is a member of a Tribe, band, or other organized group of 
Indians, including:
    i. Those Tribes, bands, or groups terminated since 1940, and
    ii. those recognized now or in the future by the State in which 
they reside, or
    b. Is a descendant, in the first or second degree, of any such 
member described in a.; or
    c. Is an Eskimo or Aleut or other Alaska Native; or
    d. Is a California Indian; \1\ or
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    \1\ Consistent with 25 U.S.C. 1603(3), (13), (28), and 1679, 
eligibility of California Indians may be demonstrated by 
documentation that the individual:
    (1) Is a descendant of an Indian who was residing in the State 
of California on June 1, 1852;
    (2) Holds trust interests in public domain, national forest, or 
Indian reservation allotments; or
    (3) Is listed on the plans for distribution of assets of 
California Rancherias and reservations under the Act of August 18, 
1958 (72 Stat. 619), or is the descendant of such an individual.
---------------------------------------------------------------------------

    e. Is considered by the Secretary of the Department of the Interior 
to be an Indian for any purpose; or
    f. Is determined to be an Indian under regulations pertaining to 
the Urban Indian Health Program that are promulgated by the Secretary, 
HHS.
    Each grantee is responsible for taking reasonable steps to confirm 
that the individual is eligible for IHS services as an urban Indian.
1. HP/DP
    Contact your IHS Area Office HP/DP Coordinator to discuss and 
identify effective and innovative strategies to promote health and 
enhance prevention efforts to address chronic diseases and conditions. 
Identify one or more of the strategies you will conduct during the 
first 12 months.
    a. Applicants are encouraged to use evidence-based and promising 
strategies which can be found at the IHS best practice database httpp:/
/www.ihs.gov/hpdp/, the National Registry for Effective Programs at 
http://www.nrepp.samhsa.gov/, and the Guide to Community Preventive 
Services at http://www.thecommunityguide.org/about/conclusionreport.html.
    b. Program Narrative. Provide a brief description of the 
collaboration activities that: (1) Were accomplished over the last 10 
months, and (2) are planned and will be conducted between your UIHP and 
the IHS Area Office HP/DP Coordinator during the budget period April 1, 
2016 through March 31, 2017.
    c. An example of an HP/DP work plan is provided on the following 
pages. Develop and attach a copy of the UIHP HP/DP Work Plan for the 
first 12 months.
2. IMMUNIZATION SERVICES
a. Program Management Required Activities
    i. Provide assurance that your facility is participating in the 
Vaccines for Children program.
    ii. Provide assurance that your facility has look up capability 
with State/regional immunization registry (where applicable). Contact 
Cecile Town at [email protected], IHS Immunization Data Exchange 
Coordinator, for more information.
b. Service Delivery Required Activities--For Sites Using RPMS
    i. Provide trainings to providers and data entry clerks on the RPMS 
Immunization package.
    ii. Establish process for immunization data entry into RPMS (e.g., 
point of service or through regular data entry).
    iii. Utilize RPMS Immunization package to identify 3-27 month old 
children who are not up to date and generate reminder/recall letters.
c. Immunization Coverage Assessment Required Activities
    i. Submit quarterly immunization reports to Area Immunization 
Coordinator for the 3-27 month old, Two year old and Adolescent, 
Influenza and Adult reports. Sites not using the RPMS Immunization 
package should submit a Two Year old immunization coverage report--an 
Excel spreadsheet with the required data elements that can be found 
under the ``Report Forms for non-RPMS sites'' section at: http://www.ihs.gov/epi/index.cfm?module=epi_vaccine_reports.
d. Program Evaluation Required Activities
    i. Report coverage with the 4313314* vaccine series for children 
19-35 months old.
    ii. Report coverage for patients (6 months and older) who received 
at least one dose of seasonal flu vaccine during flu season.
    iii. Report coverage for children 6 months-17 years and adults 18 
years and older who received at least one dose

[[Page 13386]]

of seasonal flu vaccine during flu season.
    iv. Report coverage with at least one dose of pneumococcal vaccine 
for adults 65 years and older.
    v. Establish baseline coverage on adult vaccines, specifically: 1 
dose of Tdap for adults 19 years and older; 1 dose of HPV for females 
19-26 years old; 3 doses HPV for females 19-26 years; 1 dose of HPV for 
males 19-21 years old; 3 doses HPV for males 19-21 years; and 1 dose of 
Zoster for patients 60+ years.
    * The 4:3:1:3:3:1:4 vaccine series is defined as: 4 doses 
diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and 
tetanus toxoids, or diphtheria and tetanus toxoids and any pertussis 
vaccine, 3 doses of oral or inactivated polio vaccine, 1 dose of 
measles, mumps, and rubella vaccine, 3 or 4 doses of Haemophilus 
influenzae type b vaccine depending on brand, 3 doses of hepatitis B 
vaccine, 1 dose of varicella vaccine, and 4 doses of pneumococcal 
conjugate vaccine (PCV).
3. ALCOHOL/SUBSTANCE ABUSE
    a. Program Progress Report or Results/Outcomes for the past 10 
months.
    i. Briefly address the extent to which the program was able to 
achieve its objectives over the last 10 months.
    ii. Identify Specific Program Services Outcomes/Results:
    1. State the number of patient encounters (or specific service) per 
provider staff for this program service,
    2. List populations and age groups that were targeted (homeless, 
women, children, adolescent, elderly, men, special needs, etc.), and
    3. Identify specific outcomes/results that were measured in 
addition to the number of patient encounters/staff.
    b. Narrative Description of Program Services for the first 12 
months.
i. Program Objectives
    1. Clearly state the outcomes of the health service.
    2. Define needs related outcomes of the program health care 
service.
    3. Define who is going to do what, when, how much, and how you will 
measure it.
    4. Define the population to be served and provide specific numbers 
regarding the number of eligible clients for whom services will be 
provided.
    5. State the time by which the objectives will be met.
    6. Describe objectives in numerical terms--specify the number of 
clients that will receive services.
    7. Describe how achievement of the goals will produce meaningful 
and relevant results (e.g., increase access, availability, prevention, 
outreach, pre-services, treatment, and/or intervention).
    8. Provide a one-year work plan that will include the primary 
objectives, services or program, target population, process measures, 
outcome measures, and data source for measures (see work plan sample in 
Appendix 2).
    a. Identify Services Provided: Primary Residential; Detox; Halfway 
House; Counseling; Outreach and Referral; and Other (Specify)
    b. Number of beds: Residential ___, Detox___; or Half way House 
___.
    c. Average monthly utilization for the past year.
    d. Identify Program Type: Integrated Behavioral Health; Alcohol and 
Substance Abuse only; Stand Alone; or part of a health center or 
medical establishment.
    9. Address methamphetamine-related contacts.
    a. Identify the documented number of patient contacts during the 
past twelve months, and estimate the number patient contacts during the 
first 12 months..
    b. Describe your formal methamphetamine prevention and education 
program efforts to reduce the prevalence of methamphetamine abuse 
related problems through increased outreach, education, prevention and 
treatment of methamphetamine-related issues.
    c. Describe collaborative programming with other agencies to 
coordinate medical, social, educational, and legal efforts.
ii. Program Activities
    1. Clearly describe the program activities or steps that will be 
taken to achieve the desired outcomes/results. Describe who will 
provide (program, staff) what services (modality, type, intensity, 
duration), to whom (individual characteristics), and in what context 
(system, community).
    2. State reasons for selection of activities.
    3. Describe sequence of activities.
    4. Describe program staffing in relation to number of clients to be 
served.
    5. Identify number of Full Time Equivalents (FTEs) proposed and 
adequacy of this number:
    a. Percentage of FTEs funded by IHS grant funding; and
    b. Describe clients and client selection.
    6. Address the comprehensive nature of services offered in this 
program service area.
    7. Describe and support any unusual features of the program 
services, or extraordinary social and community involvement.
    8. Present a reasonable scope of activities that can be 
accomplished within the time allotted for program and program 
resources.
iii. Accreditation and Practice Model
    1. Name of program accreditation.
    2. Type of evidence-based practice.
    3. Type of practice-based model.
iv. Attach the Alcohol/Substance Abuse Work Plan.
4. BEHAVIORAL HEALTH SERVICES
    a. Program Progress Report or Results/Outcomes for the past twelve 
months.
    i. Briefly address the extent to which the program was able to 
achieve its objectives over the past twelve months.
    ii. Identify Specific Program Services Outcomes/Results:
    1. State the number of patient encounters (or specific service) per 
provider staff for this program service,
    2. List populations and age groups that were targeted (homeless, 
women, children, adolescent, elderly, men, special needs, etc.), and
    3. Identify specific outcomes/results that were measured in 
addition to the number of patient encounters/staff.
    b. Narrative Description of Program Services for April 1, 2016--
March 31, 2017.
i. Program Objectives
    1. Clearly state the outcomes of the health service.
    2. Define needs related outcomes of the program health care 
service.
    3. Define who is going to do what, when, how much, and how you will 
measure it.
    4. Define the population to be served and provide specific numbers 
regarding the number of eligible clients for whom services will be 
provided.
    5. State the time by which the objectives will be met.
    6. Describe objectives in numerical terms--specify the number of 
clients that will receive services.
    7. Describe how achievement of the goals will produce meaningful 
and relevant results (e.g., increase access, availability, prevention, 
outreach, pre-services, treatment, and/or intervention).
    8. Provide a one-year work plan that will include the primary 
objectives, services or program, target population, process measures, 
outcome measures, and data source for measures (see work plan sample in 
Appendix 2).
    a. Identify Services Provided: Community Outreach, Prevention 
Initiatives Trainings, Court Ordered Evaluations (Adult and Juvenile),

[[Page 13387]]

Schools, Treatments, Domestic Violence Programs, Specific Groups, 
Crisis Lines, Child Protection Assistance, and Other (Specify).
    b. Identify average monthly utilization for the past year.
    c. Identify Program Type: Integrated Behavioral Health, independent 
agency, or part of a health center or medical establishment.
    9. Address Behavioral Health related contacts.
    a. Identify the documented number of patient contacts during the 
past twelve months and estimate the number patient contacts during the 
first 12 months.
    b. Describe your formal behavioral health prevention and education 
program efforts to increase access to services, outreach, education, 
prevention and treatment of behavioral health related issues.
    c. Describe collaborative programming with other agencies to 
coordinate medical, social, educational, and legal efforts.
ii. Program Activities
    1. Clearly describe the program activities or steps that will be 
taken to achieve the desired outcomes/results. Describe who will 
provide (program, staff) what services (modality, type, intensity, 
duration), to whom (individual characteristics), and in what context 
(system, community).
    2. State reasons for selection of activities.
    3. Describe sequence of activities.
    4. Describe program staffing in relation to number of clients to be 
served.
    5. Identify number of FTEs proposed and adequacy of this number:
    a. Percentage of FTEs funded by IHS grant funding; and
    b. Describe clients and client selection.
    6. Address the comprehensive nature of services offered in this 
program service area.
    7. Describe and support any unusual features of the program 
services, or extraordinary social and community involvement.
    8. Present a reasonable scope of activities that can be 
accomplished within the time allotted for program and program 
resources.
iii. Accreditation and Practice Model
    1. Name of program accreditation.
    2. Type of evidence-based practice.
    3. Type of practice-based model.
iv. Attach the Behavioral Health Work Plan
C. Project Evaluation (15 Points)
    1. Describe your evaluation plan. Provide a plan to determine the 
degree to which objectives are met and methods are followed.
    2. Describe how you will link program performance/services to 
budget expenditures. Include a discussion of GPRA/GPRAMA Report 
Measures here.
    3. Include the following program specific information:
    a. Describe the expected feasibility and reasonable outcomes (e.g., 
decreased drug use in those patients receiving services) and the means 
by which you determined these targets or results.
    b. Identify dates of reviews by the internal staff to assess 
efficacy:
    I. Assessment of staff adequacy.
    II. Assessment of current position descriptions.
    III. Assessment of impact on local community.
    IV. Involvement of local community.
    V. Adequacy of community/governance board.
    VI. Ability to leverage IHS funding to obtain additional funding.
    VII. Additional IHS grants obtained.
    VIII. New initiatives planned for funding year.
    IX. Customer satisfaction evaluations.
    4. Describe your Quality Improvement Committee (QIC).
    The UIHP QIC, a planned, organization-wide, interdisciplinary team, 
systematically improves program performance as a result of its findings 
regarding clinical, administrative and cost-of-care performance issues, 
and actual patient care outcomes including the FY 2015 GPRA report 
(results of care including safety of patients).
    a. Identify the QIC membership, roles, functions, and frequency of 
meetings. Frequency of meeting shall be at least quarterly.
    b. Describe how the results of the QIC reviews provide regular 
feedback to the program and community/governance board to improve 
services.
    1. Accomplishments during the past twelve months.
    2. Activities planned for the first 12 months.
    c. Describe how your facility is integrating the care model into 
your health delivery structure:
    1. Identify specific measures you are tracking as part of the 
Improving Patient Care (IPC) work.
    2. Identify community members that are part of your IPC team.
    3. Describe progress meeting your program's goals for the use of 
the IPC model within your healthcare delivery model.
D. Organizational Capabilities, Key Personnel and Qualifications (10 
Points)
    This section outlines the broader capacity of the organization to 
complete the project outlined in the continuation application and 
program specific work plans. This section includes the identification 
of personnel responsible for completing tasks and the chain of 
responsibility for successful completion of the project outlined in the 
work plans.
    1. Describe the organizational structure with a current approved 
one page organizational chart that shows the board of directors, key 
personnel, and staffing. Key positions include the Chief Executive 
Officer or Executive Director, Chief Financial Officer, Medical 
Director, and Information Officer.
    2. Describe the board of directors that is fully and legally 
responsible for operation and performance of the 501(c)(3) non-profit 
urban Indian organization:
    a. List all current board members by name, sex, and Tribe or race/
ethnicity,
    b. Indicate their board office held,
    c. Indicate their occupation or area of expertise,
    d. Indicate if the board member uses the UIHP services,
    e. Indicate if the board member lives in the health service area.
    f. Indicate the number of years of continuous service.
    g. Indicate number of hours of board of directors training 
provided, training dates and attach a copy of the board of directors 
training curriculum.
    3. List key personnel who will work on the project.
    a. Identify existing key personnel and new program staff to be 
hired.
    b. For all new key personnel only include position descriptions and 
resumes in the appendix. Position descriptions should clearly describe 
each position and duties indicating desired qualifications, experience, 
and requirements related to the proposed project and how they will be 
supervised. Resumes must indicate that the proposed staff member is 
qualified to carry out the proposed project activities and who will 
determine if the work of a contractor is acceptable.
    c. Identify who will be writing the progress reports.
    d. Indicate the percentage of time to be allocated to this project 
and identify the resources used to fund the remainder of the 
individual's salary if personnel are to be only partially funded by 
this grant.
E. Categorical Budget and Budget Justification (5 Points)
    This section should provide a clear estimate of the project program 
costs and justification for expenses for the first 12 months.. The 
budget and budget justification should be consistent with the tasks 
identified in the work plan.

[[Page 13388]]

    1. Categorical Budget (Form SF 424A, Budget Information Non-
Construction Programs) complete each of the budget periods requested.
    a. Provide a narrative justification for all costs, explaining why 
each line item is necessary or relevant to the proposed project. 
Include sufficient details to facilitate the determination of cost 
allowability.
    b. If indirect costs are claimed, indicate and apply the current 
negotiated rate to the budget. Include a copy of the current rate 
agreement in the appendix.
Multi-Year Project Requirements
    Projects requiring a second and/or third year must include a brief 
project narrative and budget (one additional page per year) addressing 
the developmental plans for each additional year of the project.
Additional Documents Can Be Uploaded as Appendix Items in Grant.gov
     Work Plan, logic model and/or time line for proposed 
objectives.
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Agreement.
     Organizational chart.
     Map of area identifying project location(s).
     Additional documents to support narrative (i.e. data 
tables, key news articles, etc.).

2. Review and Selection

    Each application will be prescreened by the DGM staff for 
eligibility and completeness as outlined in the funding announcement. 
Applications that meet the eligibility criteria shall be reviewed for 
merit by the ORC based on evaluation criteria in this funding 
announcement. The ORC could be composed of both Tribal and Federal 
reviewers appointed by the IHS Program to review and make 
recommendations on these applications. The technical review process 
ensures selection of quality projects in a national competition for 
limited funding. Incomplete applications and applications that are non-
responsive to the eligibility criteria will not be referred to the ORC. 
The applicant will be notified via email of this decision by the Grants 
Management Officer of the DGM. Applicants will be notified by DGM, via 
email, to outline minor missing components (i.e., budget narratives, 
audit documentation, key contact form) needed for an otherwise complete 
application. All missing documents must be sent to DGM on or before the 
due date listed in the email of notification of missing documents 
required.
    To obtain a minimum score for funding by the ORC, applicants must 
address all program requirements and provide all required 
documentation.

VI. Award Administration Information

1. Award Notices

    The Notice of Award (NoA) is a legally binding document signed by 
the Grants Management Officer and serves as the official notification 
of the grant award. The NoA will be initiated by the DGM in our grant 
system, GrantSolutions (https://www.grantsolutions.gov). Each entity 
that is approved for funding under this announcement will need to 
request or have a user account in GrantSolutions in order to retrieve 
their NoA. The NoA is the authorizing document for which funds are 
dispersed to the approved entities and reflects the amount of Federal 
funds awarded, the purpose of the grant, the terms and conditions of 
the award, the effective date of the award, and the budget/project 
period.
Disapproved Applicants
    Applicants who received a score less than the recommended funding 
level for approval, 60 points, and were deemed to be disapproved by the 
ORC, will receive an Executive Summary Statement from the IHS program 
office within 30 days of the conclusion of the ORC outlining the 
strengths and weaknesses of their application submitted. The IHS 
program office will also provide additional contact information as 
needed to address questions and concerns as well as provide technical 
assistance if desired.
Approved But Unfunded Applicants
    Approved but unfunded applicants that met the minimum scoring range 
and were deemed by the ORC to be ``Approved,'' but were not funded due 
to lack of funding, will have their applications held by DGM for a 
period of one year. If additional funding becomes available during the 
course of FY 2016, the approved, but unfunded, application may be re-
considered by the awarding program office for possible funding. The 
applicant will also receive an Executive Summary Statement from the IHS 
program office within 30 days of the conclusion of the ORC.
    Note: Any correspondence other than the official NoA signed by an 
IHS grants management official announcing to the project director that 
an award has been made to their organization is not an authorization to 
implement their program on behalf of IHS.

2. Administrative Requirements

    Grants are administered in accordance with the following 
regulations, policies, and OMB cost principles:
    A. The criteria as outlined in this program announcement.
    B. Administrative Regulations for Grants:
     Uniform Administrative Requirements for HHS Awards, 
located at 45 CFR part 75.
    C. Grants Policy:
     HHS Grants Policy Statement, Revised 01/07.
    D. Cost Principles:
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' located at 45 CFR part 75, subpart E.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' located at 45 CFR part 75, subpart F.

3. Indirect Costs

    This section applies to all grant recipients that request 
reimbursement of indirect costs (IDC) in their grant application. In 
accordance with HHS Grants Policy Statement, Part II-27, IHS requires 
applicants to obtain a current IDC rate agreement prior to award. The 
rate agreement must be prepared in accordance with the applicable cost 
principles and guidance as provided by the cognizant agency or office. 
A current rate covers the applicable grant activities under the current 
award's budget period. If the current rate is not on file with the DGM 
at the time of award, the IDC portion of the budget will be restricted. 
The restrictions remain in place until the current rate is provided to 
the DGM.
    Generally, IDC rates for IHS grantees are negotiated with the 
Division of Cost Allocation (DCA) https://rates.psc.gov/ and the 
Department of Interior (Interior Business Center) https://www.doi.gov/ibc/services/finance/indirect-Cost-Services/indian-tribes. For 
questions regarding the indirect cost policy, please call the Grants 
Management Specialist listed under ``Agency Contacts'' or the main DGM 
office at (301) 443-5204.

4. Reporting Requirements

    The grantee must submit required reports consistent with the 
applicable deadlines. Failure to submit required reports within the 
time allowed may result in suspension or termination of an active 
grant, withholding of

[[Page 13389]]

additional awards for the project, or other enforcement actions such as 
withholding of payments or converting to the reimbursement method of 
payment. Continued failure to submit required reports may result in one 
or both of the following: (1) The imposition of special award 
provisions; and (2) the non-funding or non-award of other eligible 
projects or activities. This requirement applies whether the 
delinquency is attributable to the failure of the grantee organization 
or the individual responsible for preparation of the reports. Per DGM 
policy, all reports are required to be submitted electronically by 
attaching them as a ``Grant Note'' in GrantSolutions. Personnel 
responsible for submitting reports will be required to obtain a login 
and password for GrantSolutions. Please see the Agency Contacts list in 
section VII for the systems contact information.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required semi-annually within 30 days 
after the budget period ends. These reports must include a brief 
comparison of actual accomplishments to the goals established for the 
period, a summary of progress to date or, if applicable, provide sound 
justification for the lack of progress, and other pertinent information 
as required. A final report must be submitted within 90 days of 
expiration of the budget/project period.
B. Financial Reports
    Federal Financial Report FFR (SF-425), Cash Transaction Reports are 
due 30 days after the close of every calendar quarter to the Payment 
Management Services, HHS at: http://www.dpm.psc.gov. It is recommended 
that the applicant also send a copy of the FFR (SF-425) report to the 
grants management specialist. Failure to submit timely reports may 
cause a disruption in timely payments to the organization.
    Grantees are responsible and accountable for accurate information 
being reported on all required reports: The Progress Reports and 
Federal Financial Report.
C. Federal Sub-Award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The Transparency Act requires the OMB to establish a single 
searchable database, accessible to the public, with information on 
financial assistance awards made by Federal agencies. The Transparency 
Act also includes a requirement for recipients of Federal grants to 
report information about first-tier sub-awards and executive 
compensation under Federal assistance awards.
    IHS has implemented a Term of Award into all IHS Standard Terms and 
Conditions, NoAs and funding announcements regarding the FSRS reporting 
requirement. This IHS Term of Award is applicable to all IHS grant and 
cooperative agreements issued on or after October 1, 2010, with a 
$25,000 sub-award obligation dollar threshold met for any specific 
reporting period. Additionally, all new (discretionary) IHS awards 
(where the project period is made up of more than one budget period) 
and where: (1) The project period start date was October 1, 2010 or 
after and (2) the primary awardee will have a $25,000 sub-award 
obligation dollar threshold during any specific reporting period will 
be required to address the FSRS reporting. For the full IHS award term 
implementing this requirement and additional award applicability 
information, visit the DGM Grants Policy Web site at: http://www.ihs.gov/dgm/policytopics/.
D. GPRA Report
    GPRA reports are required for the 2nd, 3rd, and 4th quarters, 
ending on December 31, March 31, and June 30 of each year. These 
reports are submitted to the site's IHS Area GPRA Coordinator by the 
date listed on the GPRA/GPRAMA Quarterly Reporting Instructions that 
are distributed each quarter by the NGST, usually 3-4 weeks after the 
end of the quarter. RPMS users must use CRS to run a quarterly GPRA 
report. Non-RPMS users must follow the quarterly instructions issued by 
the NGST to perform a 100% audit of records, and use the Excel template 
provided with the quarterly instructions to report GPRA data.
E. Quarterly Immunization Report
    Immunization reports are required quarterly. These reports are 
submitted to the IHS Area Immunization Coordinator.
F. Unmet Needs Report
    An unmet needs report is required quarterly. These reports will 
include information gathered to: (1) Identify gaps between unmet health 
needs of urban Indians and the resources available to meet such needs; 
and (2) make recommendations to the Secretary and Federal, State, 
local, and other resource agencies on methods of improving health 
service programs to meet the needs of urban Indians.
G. Compliance With Executive Order 13166 Implementation of Services 
Accessibility Provisions for All Grant Application Packages and Funding 
Opportunity Announcements
    Recipients of federal financial assistance (FFA) from HHS must 
administer their programs in compliance with federal civil rights law. 
This means that recipients of HHS funds must ensure equal access to 
their programs without regard to a person's race, color, national 
origin, disability, age and, in some circumstances, sex and religion. 
This includes ensuring your programs are accessible to persons with 
limited English proficiency. HHS provides guidance to recipients of FFA 
on meeting their legal obligation to take reasonable steps to provide 
meaningful access to their programs by persons with limited English 
proficiency. Please see http://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-VI/.
    The HHS Office for Civil Rights also provides guidance on complying 
with civil rights laws enforced by HHS. Please see http://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html; and http://www.hhs.gov/civil-rights/index.html. Recipients of FFA also have 
specific legal obligations for serving qualified individuals with 
disabilities. Please see http://www.hhs.gov/civil-rights/for-individuals/disability/index.html. Please contact the HHS Office for 
Civil Rights for more information about obligations and prohibitions 
under federal civil rights laws at http://www.hhs.gov/civil-rights/for-individuals/disability/index.html or call 1-800-368-1019 or TDD 1-800-
537-7697. Also note it is an HHS Departmental goal to ensure access to 
quality, culturally competent care, including long-term services and 
supports, for vulnerable populations. For further guidance on providing 
culturally and linguistically appropriate services, recipients should 
review the National Standards for Culturally and Linguistically 
Appropriate Services in Health and Health Care at http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.
    Pursuant to 45 CFR 80.3(d), an individual shall not be deemed 
subjected to discrimination by reason of his/her exclusion from 
benefits limited by federal law to individuals eligible for benefits 
and services from the Indian Health Service.

[[Page 13390]]

    Recipients will be required to sign the HHS-690 Assurance of 
Compliance form which can be obtained from the following Web site: 
http://www.hhs.gov/sites/default/files/forms/hhs-690.pdf, and send it 
directly to the: U.S. Department of Health and Human Services, Office 
of Civil Rights, 200 Independence Ave. SW., Washington, DC 20201.
H. Federal Awardee Performance and Integrity Information System 
(FAPIIS)
    The IHS is required to review and consider any information about 
the applicant that is in the Federal Awardee Performance and Integrity 
Information System (FAPIIS) before making any award in excess of the 
simplified acquisition threshold (currently $150,000) over the period 
of performance. An applicant may review and comment on any information 
about itself that a federal awarding agency previously entered. IHS 
will consider any comments by the applicant, in addition to other 
information in FAPIIS in making a judgment about the applicant's 
integrity, business ethics, and record of performance under federal 
awards when completing the review of risk posed by applicants as 
described in 45 CFR 75.205.
    As required by 45 CFR part 75 Appendix XII of the Uniform Guidance, 
non-federal entities (NFEs) are required to disclose in FAPIIS any 
information about criminal, civil, and administrative proceedings, and/
or affirm that there is no new information to provide. This applies to 
NFEs that receive federal awards (currently active grants, cooperative 
agreements, and procurement contracts) greater than $10,000,000 for any 
period of time during the period of performance of an award/project.
Mandatory Disclosure Requirements
    As required by 2 CFR part 200 of the Uniform Guidance, and the HHS 
implementing regulations at 45 CFR part 75, effective January 1, 2016, 
the Indian Health Service must require a non-federal entity or an 
applicant for a federal award to disclose, in a timely manner, in 
writing to the IHS or pass-through entity all violations of federal 
criminal law involving fraud, bribery,or gratutity violations 
potentially affecting the federal award.
    Submission is required for all applicants and recipients, in 
writing, to the IHS and to the HHS Office of Inspector General all 
information related to violations of federal criminal law involving 
fraud, bribery, or gratuity violations potentially affecting the 
federal award. 45 CFR 75.113
    Disclosures must be sent in writing to: U.S. Department of Health 
and Human Services, Indian Health Service, Division of Grants 
Management, ATTN: Robert Tarwater, Director, 5600 Fishers Lane, 
Mailstop 09E70, Rockville, Maryland 20857. (Include ``Mandatory Grant 
Disclosures'' in subject line) Ofc: (301) 443-5204 Fax: (301) 594-0899 
Email: [email protected].

    AND

    U.S. Department of Health and Human Services, Office of Inspector 
General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 
Independence Avenue SW., Cohen Building, Room 5527, Washington, DC 
20201. URL: http://oig.hhs.gov/fraud/reportfraud/index.asp. (Include 
``Mandatory Grant Disclosures'' in subject line) Fax: (202) 205-0604 
(Include ``Mandatory Grant Disclosures'' in subject line) or Email: 
[email protected].
    Failure to make required disclosures can result in any of the 
remedies described in 45 CFR 75.371 Remedies for noncompliance, 
including suspension or debarment (See 2 CFR parts 180 and 376 and 31 
U.S.C. 3321).

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: Rick 
Mueller, Public Health Advisor, Office of Urban Indian Health Programs, 
5600 Fishers Lane, Mail Stop: 08E65B, Rockville, MD 20857, Phone: (301) 
443-4680, Fax: (301) 443-4794, Email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Pallop Chareonvootitam, Grants Management Specialist, 5600 
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857, Phone: (301) 443-
5204, Fax: 301-594-0899, Email: [email protected].
    3. Questions on systems matters may be directed to: Paul Gettys, 
Grant Systems Coordinator, 5600 Fishers Lane, Mail Stop: 09E70, 
Rockville, MD 20857, Phone: (301) 443-2114; or the DGM main line (301) 
443-5204, Fax: (301) 594-0899, E-Mail: [email protected].

VIII. Other Information

    The Public Health Service strongly encourages all cooperative 
agreement and contract recipients to provide a smoke-free workplace and 
promote the non-use of all tobacco products. In addition, Public Law 
103-227, the Pro-Children Act of 1994, prohibits smoking in certain 
facilities (or in some cases, any portion of the facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children. This is 
consistent with the HHS mission to protect and advance the physical and 
mental health of the American people.

    Dated: March 4, 2016.
Elizabeth Fowler,
Deputy Director for Management Operations, Indian Health Service.

Sample 2016 HP/DP Work Plan

    Goal: To address physical inactivity and consumption of unhealthy 
food among youth who are in the 4th to 6th grade in the Watson, 
Kennedy, Blackwood, and Rocky Hill Elementary schools.

----------------------------------------------------------------------------------------------------------------
            Objectives                 Activities/time line       Person responsible           Evaluation
----------------------------------------------------------------------------------------------------------------
1. Develop school policies to       1. Schedule a meeting with  Program Coordinator    Progress report on status
 address physical inactivity and     the school health board     School Administrator.  of policy and
 consumption of unhealthy foods in   in the first quarter of                            documentation of number
 the first year of the funding       the project.                                       of participants in
 year.                              2. Establish a parent                               parent advisory
                                     advisory committee to                              committee, and number of
                                     assist with the                                    meetings held.
                                     development of the policy
                                     in 2nd quarter..
2. Implement a classroom nutrition  1. Design pre/post test     Program Coordinator    Pre/post knowledge,
 curriculum to increase awareness    survey and pilot test       IHS Nutritionist.      attitude, and behavior
 about the importance of healthier   with group of students by                          survey.
 foods in the four intervention      2nd quarter.                                      Document the number of
 schools by year two of the         2. Schedule a meeting with                          students who are
 funding year.                       the School Principal to                            receiving nutrition
                                     discuss dates of program                           education.
                                     implementation by 3rd
                                     quarter..
                                    3. Implement the ``Healthy
                                     Eating'' curriculum, a 6
                                     week program in the 2nd
                                     quarter..
                                    4. Collect pre/post survey
                                     at beginning and end of
                                     the program to assess
                                     changes..

[[Page 13391]]

 
3. Implement physical activity in   1. Contract with SPARK PE   Program Coordinator    1. Training evaluation
 at least four schools for grades    to train classroom          School Counselor and   and number of
 4th to 6th in first year of the     teachers to implement       PE teacher.            participants.
 funding.                            SPARK PE in the school by                         2. Pre/post FITNESSGRAM
                                     3rd Quarter.                                       Data.
                                    2. Train volunteers to
                                     administer FITNESSGRAM to
                                     collect baseline data and
                                     post data to assess
                                     changes..
----------------------------------------------------------------------------------------------------------------

Sample 2016 HP/DP Work Plan

    Goal: To reduce tobacco use among residents of community X and Y.

----------------------------------------------------------------------------------------------------------------
            Objectives                 Activities/time line       Person responsible           Evaluation
----------------------------------------------------------------------------------------------------------------
1. Establish a tobacco-free policy  1. Schedule a meeting with  Tobacco Coordinator..  Documentation of the
 in the schools and Tribal           the Tribal Council and                             number of participants.
 buildings in community X and Y by   school board to increase
 year 1.                             awareness of the health
                                     effects of tobacco by
                                     June 2016.
                                    2. Schedule and conduct     Tobacco Coordinator,   Documentation of the
                                     tobacco awareness           Health Educator.       number of participants.
                                     education in the
                                     community, schools, and
                                     worksites by July 2016
                                     through September 2017.
                                    3. Draft a policy and                              Documentation of whether
                                     present to the Tribal                              the policy was
                                     Council for approval by                            established.
                                     January 2017.
2. Coordinate and establish         1. Partner with American    Tobacco Coordinator,   Progress toward timeline.
 tobacco cessation programs with     Cancer Association and      Health Educator
 the local hospitals and clinics     the Tribal Health           Pharmacist.
 in X and Y communities.             Education Coordinators to
                                     establish 8-week tobacco
                                     cessation programs by
                                     July 2016.
                                    2. Meet with the hospital/  Tobacco Coordinator,   Progress report
                                     clinic administrators and   Health Educator.       indicating timeline is
                                     pharmacist to discuss and                          being met.
                                     develop a behavior-based
                                     tobacco cessation program.
                                    3. Train staff in tobacco   Tobacco Coordinator..  # of staff trained in
                                     cessation counseling.                              tobacco cessation.
                                    Design and disseminate      Tobacco Coordinator..  # of brochures
                                     brochures and flyers of                            distributed.
                                     tobacco cessation program
                                     that are available in the
                                     community and clinic.
                                    4. Meet with nursing and    Health Educator,       # of staff trained and
                                     medical provider staff to   Tobacco Coordinator.   document, changes in
                                     increase patient referral                          practice.
                                     to tobacco cessation
                                     program.
                                    6. Implement the 8-week     Tobacco Coordinator..  RPMS data--baseline # of
                                     tobacco cessation program                          referrals, # of
                                     at the community X and Y                           participants who
                                     clinic.                                            completed program, # who
                                                                                        quit tobacco.
----------------------------------------------------------------------------------------------------------------

Sample Urban Grant FY 2016 Work Plan

                                                  Immunization
----------------------------------------------------------------------------------------------------------------
                                   Service or          Target
 Primary prevention objective        program         population        Process measure        Outcome measures
----------------------------------------------------------------------------------------------------------------
Protect children and            Immunization      Children <3       On a quarterly basis:  As of June 30th,
 communities from vaccine        Program.          years.           # of children 3-27      2016:
 preventable diseases.                                               months old.           # of 19-35 month olds
                                                                    # of children 3-27      up to date with the
                                                                     months old who are     4313314 vaccine
                                                                     up to date with age    series.
                                                                     appropriate           % of 19-35 month olds
                                                                     vaccinations.          up to date with the
                                                                    % of 3-27 month old     4313314 vaccine
                                                                     children up to date    series.
                                                                     with age appropriate
                                                                     vaccinations..
                                                                    # of children 19-35
                                                                     months old
                                                                    # of children 19-35
                                                                     months old who
                                                                     received the 4313314
                                                                     vaccine series..
                                                                    % of children 19-35
                                                                     months old who
                                                                     received the 4313314
                                                                     vaccine series..

[[Page 13392]]

 
Protect adolescents and         Immunization      Adolescents 13-   On a quarterly basis:  As of June 30th,
 communities from vaccine        Program.          17 years.        # of adolescents 13-    2016:
 preventable diseases.                                               17 years old.         # of adolescents 13-
                                                                    # of adolescents 13-    17 years old who are
                                                                     17 years old who are   up to date with
                                                                     up to date with        Tdap, Meningococcal
                                                                     Tdap, Meningococcal,   and 3 doses of HPV.
                                                                     and 3 doses of HPV    % of adolescents 13-
                                                                     (males and females).   17 years old who are
                                                                    % of adolescents 13-    up to date with
                                                                     17 years old who are   Tdap, Meningococcal
                                                                     up to date with        and 3 doses of HPV.
                                                                     Tdap, Meningococcal,
                                                                     and 3 doses of HPV
                                                                     (males and females).
Protect adults and communities  Immunization      6 months and      On a quarterly basis   As of June 30th,
 from influenza.                 Program.          older.            during flu season      2016:
                                                                     (e.g., Sept-June)     # of patients in each
                                                                    # of patients 6         age group who
                                                                     months or older.       received a seasonal
                                                                    # of patients 6         flu shot during the
                                                                     months-17 years.       flu season.
                                                                    # of patients 18       % of patients. in
                                                                     years and older.       each age group who
                                                                    # of patients in each   received a seasonal
                                                                     age group who          flu shot during flu
                                                                     received a seasonal    season.
                                                                     flu shot during the
                                                                     flu season.
                                                                    % of patients in each
                                                                     age group who
                                                                     received a seasonal
                                                                     flu shot during flu
                                                                     season.
Protect adults and communities  Immunization      Adults >= 65      On a quarterly basis:  As of June 30th,
 from influenza & Pneumovax.     Program.          years.           # of adults >= 65       2016:
                                                                     years.                # of adults >= 65
                                                                    # of adults >= 65       years.
                                                                     years who received a  % of adults >= 65+
                                                                     pneumovax shot.        years who received a
                                                                    % of adults >= 65+      pneumovax shot ever.
                                                                     years who received a
                                                                     pneumovax shot.
----------------------------------------------------------------------------------------------------------------


                                                            IHS Urban Grant FY 2016 Work Plan
                                                   [Alcohol/Substance Abuse Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
             Objectives                Service or program       Target population       Process measure        Outcome measures       Data source for
----------------------------------------------------------------------------------------------------------------------------------        measures
                                                                                                            What information will ----------------------
                                      What type of program     Who do you hope to    What information will   you collect to find    Where will you find
 What are you trying to accomplish?      do you propose?     serve in your program?  you collect about the    out the results of    the information you
                                                                                      program activities?       your program?             collect?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To prevent substance abuse among     Community-based         American Indian youth   # of youth completing  Incidence/prevalence   Medical records, RPMS
 urban American Indian youth.         substance abuse         ages 5-18 years old.    the curriculum, # of   of substance abuse/    behavioral health
                                      prevention curriculum.                          sessions conducted,    dependence.            package, National
                                                                                      # of staff trained.                           Youth Survey.
To prevent substance abuse and       After-school, summer,   American Indian youth   # of youth completing  Incidence of           Charts, RPMS
 related problems.                    and weekend             ages 5-14 years old.    community-based        substance abuse,       behavioral health
                                      activities (e.g.                                sessions, # of         incidence of           package, National
                                      outdoor experiential                            parents completing     negative and           Youth Survey.
                                      activities, camps,                              community-based        positive attitudes
                                      classroom based                                 sessions, # of         and behaviors,
                                      problem solving                                 community-based        incidence of peer
                                      activities).                                    sessions.              drug use.
Reduce drug use and increase         Matrix model for        American Indian adult   # of clients           Incidence of drug      Medical records, RPMS
 treatment retention.                 outpatient treatment.   methamphetamine         completing program,    use, increase or       behavioral health
                                                              clients.                # of relapse           decrease in            package, Addiction
                                                                                      prevention sessions,   treatment retention,   Severity Index,
                                                                                      # of family and        positive or negative   results of urine
                                                                                      group therapies, #     urine samples.         tests.
                                                                                      of drug education
                                                                                      sessions, # of self-
                                                                                      help groups, # of
                                                                                      urine tests.
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 13393]]


                                                            IHS Urban Grant FY 2016 Work Plan
                                                        [Mental Health Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
             Objectives                Service or program       Target population       Process measure        Outcome measures       Data source for
----------------------------------------------------------------------------------------------------------------------------------        measures
                                                                                                            What information will ----------------------
                                      What type of program     Who do you hope to    What information will   you collect to find    Where will you find
 What are you trying to accomplish?      do you propose?     serve in your program?  you collect about the    out the results of    the information you
                                                                                      program activities?       your program?             collect?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To promote mental health...........  American Indian Life    American Indian youth   # of youth completing  Feelings of            Medical records, RPMS
                                      Skills Development      ages 13-17 years old.   the curriculum, # of   hopelessness,          behavioral health
                                      curriculum.                                     sessions conducted,    problem solving        package, Beck
                                                                                      # of teachers          skills.                Hopelessness Scale,
                                                                                      trained, number of                            problem solving
                                                                                      community resource                            skills.
                                                                                      leaders trained.
Improve the mental health of         Home-based, community-  American Indian         # of individual,       Reduced child          Medical records, RPMS
 American Indian children and their   based, and office-      children and their      couples, group, and    involvement in         behavioral health
 families.                            based mental health     families needing        family counseling      juvenile justice and   package coping skill
                                      counseling.             services from our       sessions, # of home,   child welfare,         measure, report
                                                              community-based         community, and         improved coping        cards, attendance
                                                              program.                office-based visits.   skills, improved       records.
                                                                                                             school attendance
                                                                                                             and grades.
Reduce symptoms related to trauma..  Mental health           American Indian adults  # of individual,       Incidence of Post-     Self-report PTSD,
                                      counseling with                                 couples, group, and    Traumatic Stress       Beck Depression
                                      cognitive behavioral                            family counseling      Disorder (PTSD)        Inventory, coping
                                      therapy intervention                            sessions, # of         symptoms, incidence    skills measure, peer
                                      and historical trauma                           historical trauma      of depression,         and family support
                                      intervention.                                   groups, # of adults    increased coping       measure, medical
                                                                                      counseled.             skills, increased      records, RPMS
                                                                                                             peer and family        behavioral health
                                                                                                             support.               package.
--------------------------------------------------------------------------------------------------------------------------------------------------------

RPMS Suicide Reporting Form

Instructions for Completing

    This form is intended as a data collection tool only. It does not 
replace documentation of clinical care in the medical record and it is 
not a referral form. HRN, Date of Act and Provider Name are required 
fields. If the information requested is not known or not listed as an 
option, choose ``Unknown'' or ``Other'' (with specification) as 
appropriate. The form can be partially completed, saved and completed 
at a later time if needed.

LOCAL CASE NUMBER:

    Indicate internal tracking number if used, not required.

DATE FORM COMPLETED:

    Indicate the date the Suicide Reporting Form was completed.

PROVIDER NAME:

    Record the name of Provider completing the form.

DATE OF ACT:

    Record Date of Act as mm/dd/yy. If exact day is unknown, use the 
month, 1st day of the month (or another default day), year. If exact 
date of act is unknown, all providers should use the same default day 
of the month.

HEALTH RECORD NUMBER:

    Record the patient's health record number.

DOB/AGE:

    Record Date of Birth as mm/dd/yy and patient's age.

SEX:

    Indicate Male or Female.

COMMUNITY WHERE ACT OCCURRED:

    Record the community code or the name, county and state of the 
community where the act occurred.

EMPLOYMENT STATUS:

    Indicate patient's employment status, choose one.

RELATIONSHIP STATUS:

    Indicate patient's relationship status, choose one.

EDUCATION:

    Select the highest level of education attained and if less than a 
High School graduate, record the highest grade completed. Choose one.

SUICIDAL BEHAVIOR:

    Identify the self-destructive act, choose one. Generally, the 
threshold for reporting should be ideation with intent and plan, or 
other acts with higher severity, either attempted or completed.

LOCATION OF ACT:

    Indicate location of act, choose one.

PREVIOUS ATTEMPTS:

    Indicate number of previous suicide attempts, choose one.

METHOD:

    Indicate method used. Multiple entries are allowed, check all that 
apply. Describe methods not listed.

SUBSTANCE USE INVOLVED:

    If known, indicate which substances the patient was under the 
influence of at the time of the act. Multiple entries allowed, check 
all that apply. List drugs not shown.

CONTRIBUTING FACTORS:

    Multiple entries allowed, check all that apply. List contributing 
factors not shown.

DISPOSITION:

    Indicate the type of follow-up planned, if known.

NARRATIVE:

    Record any other relevant clinical information not included above.
Last Updated 10/25/12
BILLING CODE 4165-16-P

[[Page 13394]]

[GRAPHIC] [TIFF OMITTED] TN14MR16.001


[[Page 13395]]


[GRAPHIC] [TIFF OMITTED] TN14MR16.002

[FR Doc. 2016-05761 Filed 3-11-16; 8:45 am]
 BILLING CODE 4165-16-C