[Federal Register Volume 86, Number 211 (Thursday, November 4, 2021)]
[Notices]
[Pages 60883-60893]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24039]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Zero Suicide Initiative
Announcement Type: New.
Funding Announcement Number: HHS-2022-IHS-ZSI-0001.
Assistance Listing (Catalog of Federal Domestic Assistance or CFDA)
Number: 93.654.
Key Dates
Application Deadline Date: February 2, 2022.
Earliest Anticipated Start Date: March 21, 2022.
I. Funding Opportunity Description
Statutory Authority
The Indian Health Service (IHS) is accepting applications for a
cooperative agreement for the Zero Suicide Initiative (ZSI). This
program is authorized under the Snyder Act, 25 U.S.C. 13; the Transfer
Act, 42 U.S.C. 2001(a); and the Indian Health Care Improvement Act, 25
U.S.C. 1665 et seq. This program is described in the Assistance
Listings located at https://sam.gov/content/home (formerly known as
Catalog of Federal Domestic Assistance) under 93.654.
Background
Since 1999, suicide rates within the Unites States have been
steadily increasing.\1\ On March 2, 2018, the Centers for Disease
Control and Prevention's Morbidity and Mortality Weekly report released
a data report, ``Suicides Among American Indian/Alaska Natives--
National Violent Death Reporting System, 18 States, 2003 to 2014,''
which highlights American Indian/Alaska Natives having the highest
rates of suicide of any racial/ethnic group in the Unites States. The
suicide rate for American Indian/Alaska Native (AI/AN) adolescents and
young adult ages 15 to 34 (19.1/100,000) was 1.3 times that of the
national average for that age group (14/100,000).\2\ In June 2019, the
National Center for Health Statistics, Health E-Stat reported in
``Suicide Rates for Females and Males by Race and Ethnicity: United
States, 1999 and 2017,'' suicide rates increased for all race and
ethnicity groups but the largest increase occurred for non-Hispanic AI/
AN females (139% from 4.6 to 11.0 per 100,000). Suicide is the 8th
leading cause of death among all AI/AN people across all ages and may
be underestimated.
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\1\ Curtin SC, Hedegaard H. Suicide rates for females and males
by race and ethnicity: United States, 1999 and 2017. NCHS Health E-
Stat. 2019.
\2\ Leavitt RA, Ertle AE, Sheats K, Petrosky E, Ivey-Stephenson
A, Fowler KA (2018) Suicides Among American Indian/Alaska Natives--
National Violent Death Reporting System, 18 States, 2003 to 2014.
MMWR Morb Mortal Wkly Rep 2018;67: 37-240.
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The `Zero Suicide' model is a key component of the National
Strategy for Suicide Prevention (NSSP) and is a priority of the
National Action Alliance for Suicide Prevention (https://theactionalliance.org/). The `Zero Suicide' model focuses on developing
a system-wide approach to improving care for individuals at risk of
suicide who are currently using health and behavioral health systems.
This award will support implementation of the `Zero Suicide' model
within Tribal and Urban Indian health care facilities and systems that
provide direct care services to AI/AN individuals in order to raise
awareness of suicide, establish integrated systems of care, and improve
outcomes for such individuals. Applicants are encouraged to visit
https://www.hhs.gov/surgeongeneral/reports-and-publications/suicide-prevention/index.html to access a copy of the 2012 National Strategy.
Purpose
The purpose of this program is to improve the system of care for
those at risk for suicide by implementing a comprehensive, culturally
informed, multi-setting approach to suicide prevention in Indian health
systems. This award represents a continuation of the IHS effort to
implement the Zero Suicide approach in Indian Country. The intent of
this announcement is to initiate a new, or build upon the previous,
Zero Suicide Initiative efforts. Existing efforts have focused on
foundational learning of the key concepts of the Zero Suicide
framework, technical assistance, and consultation for several AI/AN
Zero Suicide communities. As a result of these efforts, both the unique
opportunities and challenges of implementing Zero Suicide in Indian
Country have been identified. To best capitalize on opportunities and
surmount such challenges, this program focuses on the core Seven
Elements of the Zero Suicide model as developed by the Suicide
Prevention Resource Center (SPRC) at https://zerosuicide.edc.org/toolkit/zero-suicide-toolkit:
1. Lead--Create and sustain a leadership-driven, safety-oriented
culture committed to dramatically reducing suicide among people under
care. Include survivors of suicide attempts and suicide loss in
leadership and planning roles;
2. Train--Develop a competent, confident, and caring workforce;
3. Identify--Systematically identify and assess suicide risk among
people receiving care;
4. Engage--Ensure every individual has a pathway to care that is
both timely and adequate to meet his or her needs. Include
collaborative safety planning and restriction of lethal means;
5. Treat--Use effective, evidence-based treatments that directly
target suicidal thoughts and behaviors;
6. Transition--Provide continuous contact and support, especially
after acute care; and,
7. Improve--Apply a data-driven, quality improvement approach to
inform system changes that will lead to improved patient outcomes and
better care for those at risk.
Required, Optional, and Allowable Activities
Each applicant must describe how they plan to implement the
following core elements of this program in their project narrative and
incorporate culture within the approach to each of the seven elements.
1. Lead
a. Establish a leadership-driven strategic plan which includes
session planning (see link https://
[[Page 60884]]
zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-
template) to transform the delivery of suicide care within the health
care system.
b. Describe the organizational steps to broaden the responsibility
for suicide care across the entire health care system.
c. Detail the specific role of leadership to ensure system
transformation is achieved. Examples of leadership commitment can
include, but are not limited to: Tribal Resolutions, Tribal codes,
formal suicide care policies, and formation of Zero Suicide Initiative
advisory boards.
2. Train
a. Evaluate training needs and develop a formal training plan for
suicide prevention gatekeeper training (examples include, but are not
limited to, Question Persuade Refer, Applied Suicide Intervention
Skills Training, and Mental Health First Aid). In addition, the
training plan should include training in treating suicide risk
(examples include, but are not limited to, Dialectical Behavioral
Therapy, Cognitive Processing Therapy for Suicide Prevention, and
Cognitive Therapy for Suicidal Patients).
b. The formal training plan for staff should focus across the
health care system to strengthen and advance the skills of health care
staff and providers at all levels.
c. Training must target increasing competence in the delivery of
culturally informed, evidence-based suicide care in all health care
settings. Survey at https://zerosuicide.edc.org/sites/default/files/ZS%20Workforce%20Survey%20July%202020.pdf will be completed and
reported on at the initiation of the period of performance.
d. Train new or existing staff with an emphasis in these functions
(see link https://zerosuicide.edc.org/resources/resource-database/suicide-care-training-options).
e. Project/program oversight.
f. Case management/coordination to ensure continuity of care across
and between various departments, health care systems, and or levels of
care (e.g., transfer from high risk to low risk, discharge from
inpatient mental health care).
g. Data collection support and access for Electronic Health Record
(EHR), clinical application, project coordinator support, and other
data related activities. Adopt and/or enhance computer systems,
including management information system, EHRs, and other systems/
software, to better document and manage patient needs, the care
process, integration with related support services, and track outcomes.
3. Identify
a. Implement system-wide policies and procedures for comprehensive
suicide care standards to include, at a minimum:
i. Universal screening of all patients ages 10 and above for
suicide risk using validated instruments (see link https://zerosuicide.edc.org/resources/resource-database/ask-suicide-screening-questions-asq-toolkit).
ii. Full suicide risk assessment of all patients with positive
suicide risk screen (including risk level formulation), using (see link
https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/suicide-prevention/pages-from-suicide_prevention_compendium_5_11_20_updated-july2020_ep3_4.pdf).
iii. Individual Safety Plan for all patients with positive suicide
risk screen to include counseling patients on reduction to access of
lethal means and means restriction (see link https://www.sprc.org/resources-programs/patient-safety-plan-template).
iv. Procedure and protocol for tracking patients at increased risk
for suicide by placing patients on a suicide care management plan/
pathway. This must also address how patients are monitored while on the
plan/pathway, how often patients are re-evaluated to assess risk level,
when it is appropriate to remove patient from plan/pathway, follow-up
protocols after patients are removed from plan/pathway, etc. (see link
https://www.jointcommission.org/sea_issue_56/).
b. Develop protocols for every individual identified as at risk of
suicide to continuously monitor the individual's progress through their
EHR or other data management system to include the following:
i. Rapid follow-up of adults who have attempted suicide or
experienced a suicidal crisis after being discharged from a treatment
facility, e.g., local emergency departments, inpatient psychiatric
facilities, including direct linkage with appropriate health care
agencies to ensure coordinated care services and protocols are in place
to ensure patient safety, especially among high-risk adults with
serious mental illness. This must include outreach telephone contact
within 24 to 48 hours after discharge and securing an appointment
within 1 week of discharge (see link https://www.jointcommission.org/resources/patient-safety-topics/suicide-prevention/).
ii. Establish health system leadership including outside service
providers (i.e., local suicide prevention crisis lines to help with
follow-up contacts, etc.), and develop teams to guide the
implementation of the Zero Suicide model within their agencies.
4. Engage
a. Develop a Suicide Care Management Plan for every patient
identified as high risk of suicide (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-template). Implement a process for continuous monitoring of those
patients' progress through their EHR or other data management system,
and adjust treatment as necessary.
5. Treat
a. Develop a strategy and specific plan (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-data-elements-worksheet) to collect, analyze, and disseminate data related
to suicide care across the health care system.
b. Use a data-informed approach for quality improvement at the
levels of policy, process, and practice. Wherever possible, this
approach should include a unified EHR, or memorandum of understanding/
memorandum of agreement (MOU/MOA) to establish a process to share data
between and across systems of care for all patients in a suicide risk
clinical pathway. For example, a data report that indicates a high
percentage of patients being discharged from inpatient stays failed to
receive follow-up appointments may result in implementing a plan to
reduce that number by changing staffing patterns and processes to focus
on scheduling follow-up care.
c. Apply the use of evidence-based practices to screen, assess, and
treat individuals at risk for suicide in a way that incorporates
culturally informed practices and activities. Clearly describe how
cultural best practices and/or traditional approaches are offered,
utilized, and/or incorporated within the health care system to
complement/augment into the evidence-based protocols with those at risk
for suicide.
d. Evidence-based practices, where appropriate, may include:
i. Suicide risk screening--Ask Suicide-Screening Questions (see
link https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/index.shtml).
ii. Columbia Suicide Severity Rating Scale (see link https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english).
[[Page 60885]]
iii. Suicide Risk Assessment--Brief Suicide Safety Assessment (see
link https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/youth-outpatient/youth-outpatient-brief-suicide-safety-assessment-worksheet.shtml).
iv. Columbia Suicide Severity Rating Scale (see link https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english).
v. Suicide treatment--Dialectical Behavioral Therapy (see link
https://www.sprc.org/resources-programs/dialectical-behavior-therapy).
vi. Cognitive Therapy for Suicidal Patients (see link https://www.sprc.org/resources-programs/cognitive-therapy-suicide-prevention).
vii. Cultural best practices and/or traditional approaches--
Language immersion, traditional healers, and traditional ceremonies
(see link https://zerosuicide.edc.org/toolkit/toolkit-adaptations/indian-country).
6. Transition
a. The Suicide Care Management Plan must include the following (see
link https://zerosuicide.edc.org/resources/resource-database/best-practices-care-transitions-individuals-suicide-risk-inpatient-care):
i. Protocols for safety planning and reducing access to lethal
means in a point-to-point transition of care within a system;
ii. Rapid follow-up of adults who have attempted suicide or
experienced a suicidal crisis after being discharged from a treatment
facility (e.g., local emergency departments, inpatient psychiatric
facilities), including direct linkage with appropriate health care
agencies to ensure coordinated care services are in place;
iii. Protocols to ensure patient safety, especially among high-risk
adults in health care systems who have attempted suicide, experienced a
suicidal crisis, and/or have a serious mental illness. This must
include outreach telephone contact within 24 to 48 hours after
discharge and securing an appointment within 1 week of discharge (see
link https://zerosuicide.edc.org/toolkit/transition and/or https://theactionalliance.org/healthcare/caretransitions).
7. Improve
a. Describe the quality improvement activities that will be used to
track progress towards your process and outcome measure and how these
data will be used to inform the ongoing implementation of the project
and beyond (see link https://zerosuicide.edc.org/resources/resource-database/zero-suicide-work-plan-template).
In addition to the seven elements listed above, the following
activities are also required:
1. Seek the IHS's approval for key positions to be filled. Key
positions include, but are not limited to, the Project Director,
Project Coordinator, and Evaluator.
2. Consult and accept guidance from IHS staff on performance of
programmatic and data collection activities to achieve the goals of the
cooperative agreement.
3. Maintain ongoing communication with the IHS including a minimum
of one call per month, keeping Federal program staff informed of
emerging issues, developments, and problems as appropriate.
4. Invite the IHS Program Official to observe and provide feedback
to policy, steering, advisory, or other task forces.
5. Maintain ongoing collaboration with the IHS ZSI Technical
Assistance Coordinating Center, the Suicide Prevention Resource Center,
and the National Suicide Prevention Lifeline.
6. Provide required documentation for monthly and annual reporting
and data surveillance around suicidal behavior in selected health and
behavioral health care systems.
Practice-Based Evidence, Promising Practices, and Local Efforts
The IHS encourages the implementation of Tribal and/or culturally
appropriate suicide prevention and intervention strategies but
recognizes the limited range of formally evaluated evidence-based
practices for suicide and substance abuse that have been developed
specifically for the American Indians/Alaska Natives population. In
addition to formally evaluated practices, which exist in the research
and practice literature, evidence for other practices are allowed in
this grant program. Evidence of other practices may include unpublished
studies, preliminary evaluation results, clinical (or other
professional association) guidelines, findings from focus groups with
community members, local community surveys, etc.
Document the evidence that the practice(s) you have chosen
is appropriate for the outcomes you want to achieve.
Explain how the practice you have chosen meets the goals
for this program.
Describe any modifications/adaptations you will need to
make to your proposed practice(s) to meet the goals of your project and
why you believe the changes will improve the outcomes.
Discuss training needs or plans for training to
successfully implement the proposed evidence-based practice(s).
II. Award Information
Funding Instrument--Cooperative Agreement
Estimated Funds Available
The total funding identified for fiscal year (FY) 2022 is
approximately $2,000,000. Individual award amounts for the first budget
year are anticipated to be between $200,000 and $300,000. The funding
available for competing and subsequent continuation awards issued under
this announcement is 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 8-10 awards will be issued under this program
announcement, with a set aside of up to two awards issued to eligible
UIOs.
Period of Performance
The period of performance is for 5 years.
Cooperative Agreement
Cooperative agreements awarded by the Department of Health and
Human Services (HHS) are administered under the same policies as
grants. However, the funding agency, IHS, is anticipated to have
substantial programmatic involvement in the project during the entire
period of performance. Below is a detailed description of the level of
involvement required of the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
1. Approve all proposed key positions/personnel.
2. Facilitate linkages to other IHS/Federal government resources
and help grantees access appropriate technical assistance.
3. Assure that the grantee's project activities are aligned with
the mission, strategic goals and objectives of the IHS, and with the
goals of the Zero Suicide Initiative.
4. Coordinate cross-site evaluation participation in grantee and
staff required monitoring conference calls.
5. Promote collaboration with other IHS and Federal health and
behavioral health initiatives, including the Substance Abuse Mental
Health Services Administration (SAMHSA), the
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National Action Alliance for Suicide Prevention, the National Suicide
Prevention Lifeline, the SPRC, and the Zero Suicide Institute.
6. Provide technical assistance on all aspects of the ZSI program
implementation and sustainability.
7. Share aggregate data related to suicide behavior and clinical
care necessary to determine that the project has met expected and
identified goals, objectives, and outcomes. Describe the process of
continuous involvement based on results and analysis of the same.
III. Eligibility Information
1. Eligibility
To be eligible for this funding opportunity the applicant must be
one of the following as defined by 25 U.S.C. 1603:
A federally recognized Indian Tribe as defined by 25
U.S.C. 1603(14). The term ``Indian Tribe'' means any Indian Tribe,
band, nation, or other organized group or community, including any
Alaska Native village or group or regional or village corporation, as
defined in or established pursuant to the Alaska Native Claims
Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is
recognized as eligible for the special programs and services provided
by the United States to Indians because of their status as Indians.
A Tribal organization as defined by 25 U.S.C. 1603(26).
The term ``Tribal organization'' has the meaning given the term in
section 4 of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 5304(1)): ``Tribal organization'' means the recognized
governing body of any Indian Tribe; any legally established
organization of Indians which is controlled, sanctioned, or chartered
by such governing body or which is democratically elected by the adult
members of the Indian community to be served by such organization and
which includes the maximum participation of Indians in all phases of
its activities: Provided that, in any case where a contract is let or
grant made to an organization to perform services benefiting more than
one Indian Tribe, the approval of each such Indian Tribe shall be a
prerequisite to the letting or making of such contract or grant.
Applicant shall submit letters of support and/or Tribal Resolutions
from the Tribes to be served.
An Urban Indian organization as defined by 25 U.S.C.
1603(29). The term ``Urban Indian organization'' means a nonprofit
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). Applicants must provide proof of non-profit status with
the application, e.g., 501(c)(3).
The program office will notify any applicants deemed ineligible.
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 nonprofit status, etc.
2. Cost Sharing or Matching
The IHS does not require matching funds or cost sharing for grants
or cooperative agreements.
3. Other Requirements
Applications with budget requests that exceed the highest dollar
amount outlined under Section II Award Information, Estimated Funds
Available, or exceed the period of performance outlined under Section
II Award Information, Period of Performance, are considered not
responsive and will not be reviewed. The Division of Grants Management
(DGM) will notify the applicant.
Additional Required Documentation
Tribal Resolution
The DGM must receive an official, signed Tribal Resolution prior to
issuing a Notice of Award (NoA) to any applicant selected for funding.
An Indian Tribe or Tribal organization that is proposing a project
affecting another Indian Tribe must include resolutions from all
affected Tribes to be served. However, if an official, signed Tribal
Resolution cannot be submitted with the application prior to the
application deadline date, a draft Tribal Resolution must be submitted
with the application by the deadline date in order for the application
to be considered complete and eligible for review. The draft Tribal
Resolution is not in lieu of the required signed resolution but is
acceptable until a signed resolution is received. If an application
without a signed Tribal Resolution is selected for funding, the
applicant will be contacted by the Grants Management Specialist (GMS)
listed in this funding announcement and given 90 days to submit an
official, signed Tribal Resolution to the GMS. If the signed Tribal
Resolution is not received within 90 days, the award will be forfeited.
Tribes organized with a governing structure other than a Tribal
council may submit an equivalent document commensurate with their
governing organization.
Proof of Nonprofit Status
Organizations claiming nonprofit status must submit a current copy
of the 501(c)(3) Certificate with the application.
IV. Application and Submission Information
1. Obtaining Application Materials
The application package and detailed instructions for this
announcement are available at https://www.Grants.gov.
Please direct questions regarding the application process to Mr.
Paul Gettys at (301) 443-2114 or (301) 443-5204.
2. Content and Form Application Submission
Mandatory documents for all applicants include:
Abstract (one page) summarizing the project.
Application forms:
1. SF-424, Application for Federal Assistance.
2. SF-424A, Budget Information--Non-Construction Programs.
3. SF-424B, Assurances--Non-Construction Programs.
Project Narrative (not to exceed 30 pages). See IV.2.A,
Project Narrative for instructions.
1. Background information on the organization.
2. Proposed scope of work, objectives, and activities that provide
a description of what the applicant plans to accomplish.
Budget Justification and Narrative (not to exceed four
pages). See IV.2.B, Budget Narrative for instructions.
One-page Timeline Chart.
Tribal Resolution(s). A Tribal Resolution expressing a
bona fide commitment to a Zero Suicide model within the health and
behavioral health care system must be provided.
Letters of Support from organization's Board of Directors
(if applicable).
501(c)(3) Certificate (if applicable).
Biographical sketches for all Key Personnel.
Contractor/Consultant resumes or qualifications and scope
of work.
Disclosure of Lobbying Activities (SF-LLL), if applicant
conducts reportable lobbying.
Certification Regarding Lobbying (GG--Lobbying Form).
[[Page 60887]]
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) Financial Audit (if applicable).
Acceptable forms of documentation include:
1. Email confirmation from Federal Audit Clearinghouse (FAC) that
audits were submitted; or
2. Face sheets from audit reports. Applicants can find these on the
FAC website at https://harvester.census.gov/facdissem/Main.aspx.
Public Policy Requirements
All Federal public policies apply to IHS grants and cooperative
agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be
deemed subjected to discrimination by reason of their exclusion from
benefits limited by Federal law to individuals eligible for benefits
and services from the IHS. See https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html.
Requirements for Project and Budget Narratives
A. Project Narrative: This narrative should be a separate document
that is no more than 30 pages and must: (1) Have consecutively numbered
pages; (2) use black font 12 points or larger; (3) be single-spaced;
and (4) be formatted to fit standard letter paper (8\1/2\ x 11 inches).
Be sure to succinctly answer all questions listed under the
evaluation criteria (refer to Section V.1, Evaluation Criteria) and
place all responses and required information in the correct section
noted below or they will not be considered or scored. If the narrative
exceeds the page limit, the application will be considered not
responsive and will not be reviewed. The 30-page limit for the
narrative does not include the work plan, standard forms, Tribal
Resolutions, budget, budget justifications, narratives, and/or other
items.
There are four parts to the project narrative:
Part 1--Statement of Need;
Part 2--Implementation Approach and Work Plan;
Part 3--Organizational Capacity;
Part 4--Data Collection and Reporting.
Below are additional details about what must be included in the
project narrative.
The intent of this announcement is to initiate or build upon Zero
Suicide Initiative efforts. Applicants previously funded by IHS for ZSI
implementation must report on the status of their goals/milestones. If
goals/milestone were not achieved by those applicants, they are
expected to provide clear explanation of the barriers that prevented
the achievement of previous goal/milestones in the application to this
funding announcement.
Part 1: Statement of Need (Limit--6 Pages)
The statement of need describes the scope and scale of suicide
behavior within the community served and within the health and/or
behavioral health system. This section must identify gaps in suicide
care delivery and those gaps and any other barriers in providing
comprehensive, culturally informed care to those at risk for suicide.
The statement of need provides the facts and evidence that support the
need for the project and establishes that the Tribe, Tribal
organization, or UIO understands the problems and can reasonably
address them. Applicant's data may include the following metrics
outlined below.
Identify
Describe the proposed catchment area and demographic
information on the population(s) to receive services through the
targeted systems or agencies, e.g., race, ethnicity, federally
recognized Tribe, language, age, socioeconomic status, sex, and other
relevant factors, such as literacy.
Improve
Provide evidence of the prevalence of suicidal behavior
within the population(s) of focus, including any current limitations of
data collection in the health system. In addition, discuss how the
proposed project will address disparities in access, service use, and
outcomes for the population(s) of focus (see link https://zerosuicide.edc.org/toolkit/indian-country/improve-indian-country).
1. Number of screenings performed.
2. Number of those above screening cut off who receive a full
suicide risk assessment.
3. Numbers of those receiving a full risk assessment who have a
collaboratively developed safety plan.
4. Number of those with a collaboratively developed safety plan who
have been counseled on reduction of access to lethal means.
5. Percentage of all behavioral health clinicians who use evidence-
based practices to directly treat those at risk for suicide.
6. Percentage of follow up on those who may be at risk for suicide
to ensure safe transitions through care.
7. Percentage of documentation on every loss by suicide.
Documentation of the need for an enhanced infrastructure
(system/process improvements) to increase the capacity to implement,
sustain, and improve comprehensive, integrated, culturally informed,
evidence-based suicide care within the identified health care system
that is consistent with the purpose of the program as stated in this
announcement (see link https://zerosuicide.edc.org/resources/zero-suicide-workforce-survey-resources). This may also include a clear
description of any service gaps, staff/provider training deficits,
service delivery fragmentations, and other barriers that could impact
comprehensive suicide care for patients seen in the health system.
Applicants are encouraged to review the Zero Suicide
strategies and tools to help prepare for application to this
announcement. Please see http://zerosuicide.sprc.org/sites/zerosuicide.actionallianceforsuicideprevention.org/files/Zero%20Suicide%20Workplan%20Template%2012.6.17.pdf.
Part 2: Implementation Approach & Work Plan (Limit--9 Pages)
Applicant should develop a viable plan to address each of the 7
Elements (see link http://zerosuicide.edc.org/toolkit) in a systematic,
measureable, and interrelated manner. Evidence of plan to the
identification, use, and measurement of the use of culturally informed
practices and activities (see link https://zerosuicide.edc.org/resources/populations/native-american-and-alaska-native).
Please include a Project Timeline in the application.
Lead
A clear description of strategies to engage the highest
levels of leadership and a broad cross section of the hospital system
in order to develop organizational commitment, participation and
sustainability (Letters of Commitment should be included as
attachments). If the program is to be managed by a consortium or Tribal
organization, identify how the project office relates to the member
community/communities.
Transition
A contingency plan that addresses short-term maintenance
and long-term sustainability. How will continuity be maintained if/when
there is a change in the operational environment (e.g., health care
system leadership, staff turnover, change in project leadership, change
in elected officials, etc.) to
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ensure project stability over the period of performance. Additionally,
describe long-term plan for sustainability of the ZSI model beyond the
period of performance.
Include how your project plans to involve survivors of
suicide attempts and suicide loss in assessing, planning, and
implementing your project.
Part 3: Organizational Capacity (Limit--8 Pages)
This section focuses on how the organization may capitalize on
existing resources, processes, human capital, quality initiatives,
collaborative agreements, and surveillance capabilities as a means of
overcoming barriers to a comprehensive, culturally informed system of
suicide care.
Lead
Describe any experience (successes and/or challenges) with
the Zero Suicide model (e.g., attended a Zero Suicide Academy, etc.) or
similar collaborative efforts (e.g., patient centered medical home,
behavioral integration, trauma-informed systems, and improving patient
care, etc.).
Discuss the applicant Tribe, Tribal organization, or UIO
experience with and capacity (or detailed plan) to provide culturally
informed practices and activities for specific populations of focus.
Explain how all departments/units/divisions are (or plan
to be) involved in administering this project. You may also include how
applicant organization currently (or plans to) collaborate with other
organizations and agencies to provide care, including critical
transition of care. Provide Letter(s) of Commitment, MOA, MOUs etc.,
from CEO, Tribal Health Director, Tribal Chair, etc.
Describe the resources available for the proposed project
(e.g., facilities, equipment, information technology systems, EHR
capabilities, financial management systems, data sharing agreement,
MOUs, etc.).
List of all staff positions for the project, such as
Project Director, project coordinator, case manager and other key
personnel, and briefly describe their role and level of effort on the
project.
Part 4: Data Collection and Reporting (Limit--7 Pages)
This section of the narrative should describe function of position
and efforts to collect and report project data that will support and
demonstrate ZSI activities. All ZSI grantees will be required to
collect and report data pertaining to activities, processes, and
outcomes that support the following core elements:
Improve
Provide a clear, specific plan for how data will be
collected, managed, analyzed, and reported.
Identify which staff will be responsible for tracking the
goals and measureable objectives associated with the award.
Lead
Review of suicide care policies and procedures.
Review of any MOUs, MOAs, commitment letters, etc.
ZSI Implementation team participation.
Engagement of those that have experienced suicidal
thoughts, survived a suicide attempt, cared for someone through
suicidal crisis, or been bereaved by suicide.
Improve
Assessment of fidelity to the Zero Suicide model (to
include periodic administering of Organizational Self-Study).
Periodic assessment of staff development and training
needs (to include the periodic administering of the Workforce Survey).
Sustainability.
Measurement-based screening tools.
Review of EHR capability.
Patient satisfaction.
B. Budget Narrative (limit--4 pages). Provide a budget narrative
that explains the amounts requested for each line item of the budget
from the SF-424A (Budget Information for Non-Construction Programs).
The budget narrative should specifically describe how each item will
support the achievement of proposed objectives. Be very careful about
showing how each item in the ``Other'' category is justified. For
subsequent budget years, the narrative should highlight the changes
from year 1 or clearly indicate that there are no substantive budget
changes during the period of performance. Do NOT use the budget
narrative to expand the project narrative.
3. Submission Dates and Times
Applications must be submitted through Grants.gov by 11:59 p.m.
Eastern Time on the Application Deadline Date. Any application received
after the application deadline will not be accepted for review.
Grants.gov will notify the applicant via email if the application is
rejected.
If technical challenges arise and assistance is required with the
application process, contact Grants.gov Customer Support (see contact
information at https://www.grants.gov). If problems persist, contact
Mr. Paul Gettys ([email protected]), Acting Director, DGM, 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.
IHS will not acknowledge receipt of applications.
4. Intergovernmental Review
Executive Order 12372 requiring intergovernmental review is not
applicable to this program.
5. Funding Restrictions
Pre-award costs are allowable up to 90 days before the
start date of the award provided the costs are otherwise allowable if
awarded. Pre-award costs are incurred at the risk of the applicant.
The available funds are inclusive of direct and indirect
costs.
Only one cooperative agreement may be awarded per
applicant under this announcement.
6. Electronic Submission Requirements
All applications must be submitted via Grants.gov. Please use the
https://www.Grants.gov website to submit an application. Find the
application by selecting the ``Search Grants'' link on the homepage.
Follow the instructions for submitting an application under the Package
tab. No other method of application submission is acceptable.
If the applicant cannot submit an application through Grants.gov, a
waiver must be requested. Prior approval must be requested and obtained
from Mr. Paul Gettys, Acting Director, DGM. A written waiver request
must be sent to [email protected] with a copy to
[email protected]. The waiver request must: (1) Be documented in
writing (emails are acceptable) before submitting an application by
some other method, and (2) include clear justification for the need to
deviate from the required application submission process.
Once the waiver request has been approved, the applicant will
receive a confirmation of approval email containing submission
instructions. A copy of the written approval must be included with the
application that is submitted to the DGM. Applications that are
submitted without a copy of the signed waiver from the Acting Director
of the DGM will not be reviewed. The Grants Management Officer of the
DGM
[[Page 60889]]
will notify the applicant via email of this decision. Applications
submitted under waiver must be received by the DGM no later than 5:00
p.m., Eastern Time, on the Application Deadline Date. Late applications
will not be accepted for processing. Applicants that do not register
for both the System for Award Management (SAM) and Grants.gov and/or
fail to request timely assistance with technical issues will not be
considered for a waiver to submit an application via alternative
method.
Please be aware of the following:
Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the
Funding Opportunity Number. Both numbers are located in the header of
this announcement.
If you experience technical challenges while submitting
your application, please contact Grants.gov Customer Support (see
contact information at https://www.grants.gov).
Upon contacting Grants.gov, obtain a tracking number as
proof of contact. The tracking number is helpful if there are technical
issues that cannot be resolved and a waiver from the agency must be
obtained.
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 twenty
working days.
Please follow the instructions on Grants.gov to include
additional documentation that may be requested by this funding
announcement.
Applicants must comply with any page limits described in
this funding announcement.
After submitting the application, the applicant will
receive an automatic acknowledgment from Grants.gov that contains a
Grants.gov tracking number. The IHS will not notify the applicant that
the application has been received.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
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
that 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 the request service through https://fedgov.dnb.com/webform, or call (866) 705-5711.
The Federal Funding Accountability and Transparency Act of 2006, as
amended (``Transparency Act''), requires all HHS recipients 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 are not registered with SAM must have a DUNS
number first, then access the SAM online registration through the SAM
home page at https://www.sam.gov/SAM/ (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). Please see SAM.gov for details on the registration process and
timeline. Registration with the SAM is free of charge but can take
several weeks to process. Applicants may register online at https://www.sam.gov/SAM/.
Additional information on implementing the Transparency Act,
including the specific requirements for DUNS and SAM, are available on
the DGM Grants Management, Policy Topics web page: https://www.ihs.gov/dgm/policytopics/.
V. Application Review Information
Possible points assigned to each section are noted in parentheses.
The 30-page project narrative should include only the first year of
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 section should be written
in a manner that is clear to outside reviewers unfamiliar with prior
related activities of the applicant. It should be well organized,
succinct, and contain all information necessary for reviewers to
understand the project fully. Points will be assigned to each
evaluation criteria adding up to a total of 100 possible points. Points
are assigned as follows:
1. Evaluation Criteria
Applications will be reviewed and scored according to the quality
of responses to the required application components in Sections A-E.
The points listed after each heading is the maximum number of points a
reviewer may assign to that section.
A. Statement of Need (10 Points)
The criteria being evaluated is the quality of your strategic
approach and logical steps to implement a Zero Suicide Initiative
within your health system. The following aspects will be assessed:
1. The degree to which the applicant's description of the service
area/target population demonstrates the need for a systems approach to
suicide care within the health and behavioral health systems.
2. How well the applicant describes the unique characteristics of
the service area and population and systems barriers/gaps that impact
the delivery of comprehensive suicide care.
B. Implementation Approach & Work Plan (30 Points)
1. A viable plan to address each of the 7 Elements of the Zero
Suicide model and the required activities (described in Section 1) in a
systematic, measureable, and interrelated manner. Develop strategy to
collect, and analyze application of evidence-based practices to screen,
assess, and treat individuals' use of culturally informed practices and
activities. (See Resources for Native American and Alaska Native
Populations at https://zerosuicide.edc.org/resources/populations/native-american-and-alaska-native).
2. A clear description of strategies to engage the highest levels
of leadership and a broad cross section of the behavioral/healthcare
system in order to develop organizational commitment, participation and
sustainability (Letters of Commitment, MOUs, MOAs, etc., should be
included as attachments). If the program is to be managed by a
consortium or Tribal organization, identify how the project office
relates to the member community/communities. Should include how you
plan to involve survivors of suicide attempts and suicide loss in
assessing, planning, and implementing your project.
3. Address how continuity will be maintained if/when there is a
change in the operational environment (e.g., health care system
leadership, staff turnover, change in project leadership, change in
elected officials, etc.) to ensure project stability over the period of
performance. Additionally, describe the long-term plan for
sustainability of the ZSI model beyond the period of performance.
C. Organizational Capacity (30 Points)
1. The extent to which the applicant describes experience
(successes and/or challenges) with the Zero Suicide model
[[Page 60890]]
(e.g., attended a Zero Suicide Academy, etc.) or similar collaborative
efforts (e.g., patient centered medical home, behavioral integration,
trauma informed systems, and improving patient care, etc.), focused on
a comprehensive approach to suicide care across a healthcare system.
2. The extent to which the applicant describes experience with and
capacity (or detailed plan) to provide culturally informed practices
and activities for specific populations of focus. Must refer to Tribal
Resolution.
3. Identification of how all departments/units/divisions across the
health care system will be involved in administering this project. May
also include how applicant organization currently (or plans to)
collaborate with other organizations and agencies to provide care,
including critical transition of care.
4. Describe the resources available to implement and sustain the
proposed project (e.g., facilities, equipment, information technology
systems, financial management systems, data sharing agreement, MOUs,
etc.).
Listing of all staff positions for the project, such as Project
Director, project coordinator, and other key personnel, showing the
role of each and their level of effort and qualifications. Demonstrate
successful project implementation for the level of effort budgeted for
Project Director, project coordinator, and other key staff.
Include position descriptions as attachments to the application.
Describe the function within each position providing services in
suicide care, behavioral health and primary care and other health care
services, quality and process improvement, and related work within the
community/communities.
5. Applicants previously funded by the IHS for ZSI implementation
must report on the status of their goals/milestones in this section of
the program narrative. If goals/milestones were not achieved by those
applicants, they are expected to provide clear explanation of the
barriers that prevented the achievement of previous goals/milestones.
D. Data Collection, Performance Assessment and Evaluation (25 Points)
In this area, applicants need to clearly demonstrate the ability to
collect and report on required data elements associated with Zero
Suicide and this particular project, and engage in all aspects of local
and national evaluation. The following aspects will be assessed:
Ability to collect and report on the required performance
measures specified in the Data Collection and Performance Management
section.
A clear, specific plan for data collection, management,
analysis, and reporting. Indication of the staff person(s) responsible
for tracking the measureable objectives that are identified above.
Description of your plan for conducting the local
performance assessment, as specified above, and evidence of your
ability to conduct the assessment.
Description of the quality improvement process that will
be used to track progress towards your performance measures and
objectives, and how these data will be used to inform the ongoing
implementation of the project and beyond.
E. Categorical Budget and Budget Justification (5 Points)
Applicants must provide a budget and narrative justification for
the proposed project budget.
1. Evidence of reasonable, allowable costs necessary to achieve the
objective outlined in the project narrative.
2. Description of how the budget aligns with the overall scope of
work.
3. Please use Budget/Budget Narrative Template Worksheet to support
your responses in this section.
The Timeline Chart, Local Data Collection Plan Worksheet, and
Budget/Budget Narrative templates can be downloaded at the ZSI website
at https://www.ihs.gov/zerosuicide/.
Multi-Year Project Requirements
Applications must include a brief project narrative and budget (one
additional page per year) addressing the developmental plans for each
additional year of the project. This attachment will not count as part
of the project narrative or the budget narrative.
Additional documents can be uploaded as Other Attachments in
Grants.gov. These can include:
Work plan, logic model, and/or timeline for proposed
objectives.
Position descriptions for staff.
Consultant or contractor proposed scope of work and letter
of commitment (if applicable).
Current Indirect Cost Rate 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 for eligibility and
completeness as outlined in the funding announcement. Applications that
meet the eligibility criteria shall be reviewed for merit by the
Objective Review Committee (ORC) based on evaluation criteria.
Incomplete applications and applications that are not responsive to the
administrative thresholds (budget limit, project period limit) will not
be referred to the ORC and will not be funded. The applicant will be
notified of this determination.
Applicants must address all program requirements and provide all
required documentation.
3. Notifications of Disposition
All applicants will receive an Executive Summary Statement from the
IHS Division of Behavioral Health within 30 days of the conclusion of
the ORC outlining the strengths and weaknesses of their application.
The summary statement will be sent to the Authorizing Official
identified on the face page (SF-424) of the application.
A. Award Notices for Funded Applications
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 award, the terms and conditions of the
award, the effective date of the award, and the budget/project period.
Each entity approved for funding must have a user account in
GrantSolutions in order to retrieve the NoA. Please see the Agency
Contacts list in Section VII for the systems contact information.
B. Approved but Unfunded Applications
Approved applications not funded due to lack of available funds
will be held for 1 year. If funding becomes available during the course
of the year, the application may be reconsidered.
Note: Any correspondence other than the official NoA executed 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 the IHS.
VI. Award Administration Information
1. Administrative Requirements
Awards issued under this announcement are subject to, and are
administered in accordance with, the following regulations and
policies:
A. The criteria as outlined in this program announcement.
B. Administrative Regulations for Grants:
Uniform Administrative Requirements, Cost Principles, and
[[Page 60891]]
Audit Requirements for HHS Awards currently in effect or implemented
during the period of award, other Department regulations and policies
in effect at the time of award, and applicable statutory provisions. At
the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/content/pkg/CFR-2020-title45-vol1/pdf/CFR-2020-title45-vol1-part75.pdf.
Please review all HHS regulatory provisions for
Termination at 45 CFR 75.372, at https://www.ecfr.gov/cgi-bin/retrieveECFR?gp&;SID=2970eec67399fab1413ede53d7895d99&mc=true&
;n=pt45.1.75&r=PART&ty=HTML&se45.1.75_1372#se45.1.75_1372.
C. Grants Policy:
HHS Grants Policy Statement, Revised January 2007, at
https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
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.
F. As of August 13, 2020, 2 CFR 200 was updated to include a
prohibition on certain telecommunications and video surveillance
services or equipment. This prohibition is described in 2 CFR 200.216.
This will also be described in the terms and conditions of every IHS
grant and cooperative agreement awarded on or after August 13, 2020.
2. Indirect Costs
This section applies to all recipients that request reimbursement
of indirect costs (IDC) in their application budget. In accordance with
HHS Grants Policy Statement, Part II-27, IHS requires applicants to
obtain a current IDC rate agreement and submit it to the DGM prior to
the DGM issuing an 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 agreement 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 agreement is
provided to the DGM.
Per 45 CFR 75.414(f) Indirect (F&A) costs, ``any non-Federal entity
(NFE) [i.e., applicant] that has never received a negotiated indirect
cost rate, . . . may elect to charge a de minimis rate of 10 percent of
modified total direct costs which may be used indefinitely. As
described in Section 75.403, costs must be consistently charged as
either indirect or direct costs, but may not be double charged or
inconsistently charged as both. If chosen, this methodology once
elected must be used consistently for all Federal awards until such
time as the NFE chooses to negotiate for a rate, which the NFE may
apply to do at any time.''
Electing to charge a de minimis rate of 10 percent only applies to
applicants that have never received an approved negotiated indirect
cost rate from HHS or another cognizant Federal agency. Applicants
awaiting approval of their indirect cost proposal may request the 10
percent de minimis rate. When the applicant chooses this method, costs
included in the indirect cost pool must not be charged as direct costs
to the grant.
Available funds are inclusive of direct and appropriate indirect
costs. Approved indirect funds are awarded as part of the award amount,
and no additional funds will be provided.
Generally, IDC rates for IHS grantees are negotiated with the
Division of Cost Allocation at https://rates.psc.gov/ or the Department
of the Interior (Interior Business Center) at https://ibc.doi.gov/ICS/tribal. 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.
3. 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 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 the imposition of special award
provisions and/or 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 must 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 annually. The progress
reports are due within 30 days after the budget period ends (specific
dates will be listed in the NoA Terms and Conditions). 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, and any other specific
evaluation requirements described in this funding announcement. A final
report must be submitted within 90 days of expiration of the period of
performance. This final report must provide a comprehensive summary of
accomplishments and outcomes over the period of performance as related
to each of the stated goals.
B. Financial Reports
Federal Cash Transaction Reports are due 30 days after the close of
every calendar quarter to the Payment Management Services at https://pms.psc.gov. Failure to submit timely reports may result in adverse
award actions blocking access to funds.
Federal Financial Reports are due 30 days after the end of each
budget period, and a final report is due 90 days after the end of the
period of performance.
Grantees are responsible and accountable for reporting accurate
information on all required reports: The Progress Reports, the Federal
Cash Transaction Report, and Federal Financial Report.
C. Data Collection and Reporting
In addition to the annual progress reports, the IHS will compile
and provide aggregate program statistics including associated
community-level Government Performance Results Act health care facility
data available in the National Data Warehouse, as needed.
Awardees will be required to report on the following:
Treat
Total number of patient visits; total number of patients
screened for suicide risk;
total number of patients assessed for suicide risk;
total number of patients placed on suicide care pathway or
registry;
total number of patients hospitalized for suicide risk;
[[Page 60892]]
total number of patients with safety plan;
total number of patients counseled on access to lethal
means.
Train
Total number of staff trained, number of trainings, type
of trainings and number of staff trained in each healthcare profession
in evidenced-based treatment of suicide risk.
Awardees will also be required to submit their annual progress
reports into an online reporting system funded by the IHS.
D. 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.
The 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 threshold met for any specific
reporting period.
For the full IHS award term implementing this requirement and
additional award applicability information, visit the DGM Grants
Management website at https://www.ihs.gov/dgm/policytopics/.
E. Compliance With Executive Order 13166 Implementation of Services
Accessibility Provisions for All Grant Application Packages and Funding
Opportunity Announcements
Should you successfully compete for an award, recipients of Federal
financial assistance (FFA) from HHS must administer their programs in
compliance with Federal civil rights laws that prohibit discrimination
on the basis of race, color, national origin, disability, age and, in
some circumstances, religion, conscience, and sex (including gender
identity, sexual orientation, and pregnancy). This includes ensuring
programs are accessible to persons with limited English proficiency and
persons with disabilities. The HHS Office for Civil Rights provides
guidance on complying with civil rights laws enforced by HHS. Please
see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html.
Recipients of FFA must ensure that their programs are
accessible to persons with limited English proficiency. For guidance on
meeting your legal obligation to take reasonable steps to ensure
meaningful access to your programs or activities by limited English
proficiency individuals, see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html and https://www.lep.gov.
For information on your specific legal obligations for
serving qualified individuals with disabilities, including reasonable
modifications and making services accessible to them, see https://www.hhs.gov/ocr/civilrights/understanding/disability/index.html.
HHS funded health and education programs must be
administered in an environment free of sexual harassment. See https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html.
For guidance on administering your program in compliance
with applicable Federal religious nondiscrimination laws and applicable
Federal conscience protection and associated anti-discrimination laws,
see https://www.hhs.gov/conscience/conscience-protections/index.html
and https://www.hhs.gov/conscience/religious-freedom/index.html.
F. 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 FAPIIS at https://www.fapiis.gov before
making any award in excess of the simplified acquisition threshold
(currently $250,000) 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,
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, the IHS must require an NFE
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 gratuity violations
potentially affecting the Federal award.
All applicants and recipients must disclose in writing, in a timely
manner, 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: Paul Gettys, Acting Director, 5600
Fishers Lane, Mail Stop: 09E70, Rockville, MD 20857. (Include
``Mandatory Grant Disclosures'' in subject line), Office: (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: https://oig.hhs.gov/fraud/report-fraud/. (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 part 180 and 2 CFR part
376).
VII. Agency Contacts
1. Questions on the programmatic issues may be directed to: LCDR
Monique Richards, MSW, LICSW,
[[Page 60893]]
Public Health Advisor, Indian Health Service, Division of Behavioral
Health, 5600 Fishers Lane, Mail Stop: 08N70C, Rockville, MD 20857,
Telephone: (240) 252-9625, Fax: (301) 443-5610, Email:
[email protected].
2. Questions on grants management and fiscal matters may be
directed to: Sheila Miller, Grants Management Specialist, Indian Health
Service, Division of Grants Management, 5600 Fishers Lane, Mail Stop:
09E70, Rockville, MD 20857, Phone: (240) 535-9308, Fax: (301) 594-0899,
Email: [email protected].
3. Questions on systems matters may be directed to: Paul Gettys,
Acting Director, Division of Grants Management, Indian Health Service,
Division of Grants Management, 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, email: [email protected].
VIII. Other Information
The Public Health Service strongly encourages all grant,
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.
Elizabeth A. Fowler,
Acting Director, Indian Health Service.
[FR Doc. 2021-24039 Filed 11-3-21; 8:45 am]
BILLING CODE 4165-16-P