[Federal Register Volume 87, Number 74 (Monday, April 18, 2022)]
[Pages 22924-22932]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-08249]



Indian Health Service

Addressing Dementia in Indian Country: Models of Care

    Announcement Type: New.
    Funding Announcement Number: HHS-2022-IHS-ALZ-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.933.

Key Dates

    Application Deadline Date: July 18, 2022.
    Earliest Anticipated Start Date: August 31, 2022.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for 
cooperative agreements for Addressing Dementia in Indian Country. 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. 1665a(c)(5)(F) and 1660e. This program is described in the 
Assistance Listings located at https://sam.gov/content/home (formerly 
known as the CFDA) under 93.933.


    Alzheimer's disease and Alzheimer's disease-related dementias 
affect lives in every Tribal and Urban Indian community. Alzheimer's 
disease is the most common cause of dementia--a progressive cognitive 
impairment that adversely affects function. Other forms

[[Page 22925]]

of dementia include vascular dementia, Lewy-Body Disease, Fronto-
Temporal Dementia, alcohol-related dementia, dementia related to 
traumatic brain injury, and mixed dementia (attributable to more than 
one cause of cognitive impairment). Age is the most significant risk 
factor for Alzheimer's disease. Although the average age of American 
Indians and Alaska Natives (AI/AN) is younger than the population as a 
whole, the group age 65 and older is growing more rapidly than the 
United States (U.S.) population. The Centers for Disease Control and 
Prevention (CDC) notes that the number of AI/AN age 65 and older is 
expected to triple in the next 30 years, with the oldest--those 85 
years and older--increasing even more rapidly. While age is the most 
substantial risk factor for Alzheimer's disease, early-onset occurs in 
younger populations and in persons with Down Syndrome or Trisomy 21, 
who are at markedly increased risk for Alzheimer's Disease. Conditions 
such as diabetes, cardiovascular disease, chronic kidney disease, 
chronic liver disease, and traumatic brain injury increase the risk of 
dementia and can lead to a more rapid worsening.
    Dementia of all types is under-recognized, underdiagnosed, and 
undertreated in all populations in the U.S., and anecdotal evidence 
suggests that this is very much true for the AI/AN population. Many 
individuals go unrecognized in the community, never seeking care and 
living with impaired cognition that puts them at risk for financial 
exploitation, poor health outcomes, and accidental injury. Individuals 
and their families may not recognize the cognitive changes that 
dementia brings. They may think the changes are due to normal aging or 
may accept the changes and not seek care out of concern for the elder's 
dignity. Failure to recognize dementia may also stem from the stigma 
associated with dementia and from lack of awareness of resources 
available. Often it takes a crisis or illness to bring attention to the 
condition. Diagnosis of dementia is most often made in the primary care 
office or clinic, with specialty referral needed when the presentation 
is not typical or apparent. But primary care providers may lack the 
confidence to make the diagnosis or plan effective care and may not 
have access to an interdisciplinary team to support care or specialists 
through consultation or referral to support diagnosis and management 
decisions. Effective management of dementia crosses many boundaries, 
involving medical care, personal care, social services, legal and 
financial services, and housing. Management of dementia requires 
coordination between clinical services and community-based services. 
Those living with dementia and their caregivers are too often left to 
coordinate this complex care themselves. Most persons living with 
dementia receive some care and assistance from caregivers, and 
sometimes from family members. Care for the person living with dementia 
should include consideration for their caregivers but, unfortunately, 
this is not common.
    Effective models for addressing dementia in Tribal and Urban Indian 
communities will be supported by evidence and will emerge through 
development or adaptation and evaluation from those communities. A 
recent report by the Agency for Healthcare Research and Quality and the 
National Academies of Science, Engineering, and Medicine point to the 
Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) 
caregiver support intervention and models of coordinated care as 
interventions that have evidence for benefit and are ready for 
implementation and further evaluation.\1\ The REACH into Indian Country 
initiative successfully trained public and community health nurses to 
provide the REACH intervention in Tribal communities. Communities 
across the country, including some Tribal communities, use the 
Dementia-Friendly Communities approach to building community-based 
efforts to improve care for persons living with dementia and their 
families.\2\ The Healthy Brain Initiative Roadmap for Indian Country, 
developed by the CDC and the Alzheimer's Association, is designed to 
support discussion about dementia and caregiving with Tribal 
communities and encourage a public health approach as part of a larger 
holistic response.\3\ These models can help inform the design of Tribal 
and Urban Indian health models.

    \1\ National Academies of Sciences, Engineering, and Medicine. 
2021. Meeting the challenge of caring for persons living with 
dementia and their care partners and caregivers: A way forward. 
Washington, DC: The National Academies Press. https://doi.org/10.17226/26026.
    \2\ Dementia Friendly America https://www.dfamerica.org https://iasquared.org/news-release-ia2-is-now-a-national-dementia-friends-sub-licensee-for-american-indian-and-alaska-native-tribal-communities/.
    \3\ https://www.cdc.gov/aging/healthybrain/indian-country-roadmap.html.


    The purpose of this program is to support the development of models 
of comprehensive and sustainable dementia care and services in Tribal 
and Urban Indian communities that are responsive to the needs of 
persons living with dementia and their caregivers. Awardees will:
    1. Plan and implement a comprehensive approach to care and services 
for persons living with dementia and their caregivers that addresses:
     Awareness and Recognition. Enhance awareness and early 
recognition of dementia in the community and increase referral to 
clinical care for evaluation leading to diagnosis. The United States 
Preventive Services Task Force has concluded that ``current evidence is 
insufficient to assess the benefits and harms of screening for 
cognitive impairment in older adults.'' Still, there is broad consensus 
supporting case findings to promote early recognition and diagnosis of 
     Accurate and Timely Diagnosis. Individuals and their 
families should have confidence that concerns about potential cognitive 
impairment will be evaluated thoroughly and lead to an accurate and 
timely diagnosis. Most diagnoses of dementia can be made in primary 
care, but clinical programs should have referral and consultation 
mechanisms in place (either in person or via telehealth) to support 
diagnosis when needed.
     Interdisciplinary Assessment. Persons living with dementia 
will have complex and evolving care needs. An interdisciplinary 
assessment helps identify goals of care and gaps in services and sets 
the stage for appropriate care and services. In best practice, this 
assessment includes an attempt to understand the cultural, religious, 
and personal values that will guide goals and preferences for care. It 
assesses family and other caregiving resources and the needs and 
capabilities of those partners in care, as well as housing security and 
safety risks.
     Management and Referral. Care for the person living with 
dementia is guided by the assessment and most often requires 
coordination of health care and social services to meet their needs and 
support caregivers. Those living with dementia and their caregivers 
often need support and assistance in navigating through the various 
systems providing this care.
     Support for Caregivers. Care for persons living with 
dementia includes care for their caregivers. Families and other 
caregivers need help in navigating services and mobilizing respite 
care, help in understanding what to expect and how to respond to the 
challenges of living with dementia, and support for

[[Page 22926]]

self-care. Interventions that provide that care and support (e.g., 
REACH) and provide education and training (e.g., Savvy Caregiver) have 
been adapted for use in Tribal communities.
    2. Develop, in collaboration with the IHS, best and promising 
practices to include tools, resources, reports, and presentations 
accessible to Federal, Tribal, and urban health programs as they plan 
and implement their own programs.
    3. Identify and implement reimbursement and funding streams that 
will support service delivery and facilitate sustainability. 
Opportunities for reimbursement and funding streams dependent on the 
specific interventions planned, but potential sources might include:
     Medicare reimbursement through the Physician Fee Schedule, 
including Cognitive Assessment and Planning codes and Chronic and 
Complex Care Management codes.
     Medicaid and other state programs.
     Purchased and Referred Care resources.
     IHS and Third Party Revenue.
    The IHS Alzheimer's Grant Program will provide technical assistance 
to grantees in development of a plan for sustainability.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2022 is 
approximately $1,000,000. Individual award amounts for the first budget 
year are anticipated to be between $100,000 and $200,000. 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 five awards will be issued under this program 
Period of Performance
    The period of performance is for 2 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
    A. The IHS Office of Clinical and Preventive Services (OCPS), 
Division of Clinical and Community Services (DCCS), will collaborate 
with recipients throughout the process of planning and implementation 
and assist in the identification of tools, resources, reports, and 
presentations for dissemination to other Tribal, the IHS, and urban 
programs. The DCCS will also provide technical assistance in developing 
a sustainability plan.
    B. The IHS will convene recipients periodically, not more often 
than monthly, to share ideas, strategies, and tools to accelerate 
design and implementation progress.
    C. DCCS will link recipients with Federal agencies and non-
governmental organizations working to improve the care of persons 
living with dementia and their caregivers.
    D. DCCS will coordinate reporting (e.g., identified metrics 
utilized, achieved goals, identified best practices, etc.) and 
technical assistance (e.g., programmatic support to Tribal communities) 
as required.

III. Eligibility Information

1. Eligibility

    To be eligible under this announcement, an 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 non-profit 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.
Tribal Resolution
    The DGM must receive an official, signed Tribal Resolution prior to 
issuing a Notice of Award (NoA) to any Tribe or Tribal organization 
selected for funding. An applicant that is proposing a project 
affecting another Indian Tribe must include resolutions from all

[[Page 22927]]

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.

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 10 pages). See Section 
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 five 
pages). See Section IV.2.B, Budget Narrative for instructions.
     One-page Timeframe Chart.
     Tribal Resolution(s), if applicable.
     Letters of Support from organization's Board of Directors 
     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).
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Organizational Chart.
     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://facdissem.census.gov/.
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 
10 pages and must: (1) Have consecutively numbered pages; (2) use black 
font 12 points or larger (applicants may use 10 point font for tables); 
(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 10-page limit for the 
narrative does not include the work plan, standard forms, Tribal 
Resolutions, budget, budget justifications, narratives, and/or other 
    There are three parts to the narrative: Part 1--Program 
Information; Part 2--Program Planning and Evaluation; and Part 3--
Sharing with Other Tribes, Tribal Organizations, and Urban Indian 
Organizations. See below for additional details about what must be 
included in the narrative.
    The page limits below are for each narrative and budget submitted.
Part 1: Program Information (Limit--4 Pages)
Section 1: Tribal or Organizational Overview
    Provide a brief description of the Tribe, Tribal organization, or 
Urban Indian health program, health care delivery system and resources, 
elderly services and resources, long-term services and supports, and 
other Tribal or community-based services that might be involved.
Section 2: Needs
    Provide any data available about the number of persons living with 
dementia and their needs and the needs of their caregivers. If data is 
not currently available, indicate this here and in Part 2 below, and 
describe in detail how the applicant will obtain or develop this data 
in the first year of the program.
Section 3: Other Funded Initiatives
    Provide information about other funded initiatives addressing 
dementia that the applicant is or will be participating in that are 
relevant to this proposal. Indicate any HHS grants addressing dementia 
(e.g. Dementia Capability in Indian Country Grant program of the 
Administration for Community Living) the applicant has been awarded 
whose period of performance may overlap the period of performance of 
this grant opportunity.
Part 2: Program Planning and Evaluation (Limit--4 Pages)
Section 1: Program Plans
    Describe fully and clearly the applicant's plan to implement a 
comprehensive approach to care and services for persons living with 
dementia and their caregivers and identify funding streams that will 
support service delivery. The plan should include a vision for a 
comprehensive approach to care, recognizing that achievement of the 
fully implemented approach may not be feasible within the period of 
Section 2: Program Evaluation
    Describe fully and clearly the elements of the comprehensive 
approach to care described in Section 1 that the applicant expects to 

[[Page 22928]]

over the period of performance. Describe the metrics that will be used 
to assess the achievement of these goals. If the applicant will need to 
obtain or develop data about the number of persons living with dementia 
and their needs and the needs of their caregivers as an element of this 
award, the applicant should indicate that data and describe how that 
data will be developed or acquired in the first year.
Part 3: Sharing With Other Tribes, Tribal Organizations, and Urban 
Indian Organizations (Limit--2 Pages)
Section 1
    Describe how your program will develop, in collaboration with the 
IHS, best and promising practices that includes tools, resources, 
reports, and presentations, accessible to stakeholders across the 
Tribal health system including Tribal and urban health partners.
B. Budget Narrative (Limit--5 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 can include a more 
detailed spreadsheet than is provided by the SF-424A. 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 (see Multi-Year Project Requirements in Section V.1, Application 
Review Information, Evaluation Criteria), 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 
    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]), Deputy Director, DGM, by 
telephone at (301) 443-2114 or (301) 443-5204. Please be sure to 
contact Mr. Gettys at least 10 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.
    The 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 
     Only one cooperative agreement may be awarded per 

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, Deputy 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 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 
    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 
     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 20 
working days.
     Please follow the instructions on Grants.gov to include 
additional documentation that may be requested by this funding 
     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 recipients must notify 
potential first-tier sub-recipients that no entity may receive a first-
tier sub-award unless the entity has

[[Page 22929]]

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://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). 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://sam.gov.
    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 at https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The project narrative and budget narrative should include only the 
first year of activities; information for multi-year projects should be 
included as a separate document. See ``Multi-year Project 
Requirements'' at the end of this section for more information. The 
project 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 fully understand the project. 
Attachments requested in the criteria do not count toward the page 
limit for the narratives. 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

A. Introduction and Need for Assistance (10 Points)
    1. Description of the clinical services, elder services and 
resources, long-term care services, and supports available through the 
applicant's organization, either as a direct service or through 
agreement, contract, or Purchased and Referred Care (PRC). Applicants 
must be able to provide ambulatory care services directly or through 
coordination with IHS Direct Services and must be able to coordinate 
with elder services.
    2. Description of the number of individuals living with dementia to 
be served, any data available about the prevalence of risk factors for 
dementia (including age as reflected in the population's demographics), 
and any limitations of the data available.
    3. Identification of the most urgent and pressing gaps in 
availability or quality of care and services for persons living with 
dementia and their families. If this information is not available, the 
acquisition of this information should be a detailed part of the 
Project Objective(s), Work Plan, and Approach.
    4. If the applicant is the recipient of other HHS grants that will 
provide funding to address dementia over the same time period (e.g. 
Dementia Capability in Indian Country Grant program of the 
Administration for Community Living), address how funding under this 
opportunity will address the need without overlapping the activities of 
other funded awards, if applicable.
B. Project Objective(s), Work Plan, and Approach (30 Points)
    1. The overall vision for a comprehensive approach to care and 
services for persons living with dementia and their caregivers, 
     Awareness and recognition.
     Timely and accurate diagnosis.
     Multidisciplinary assessment.
     Management and referral.
     Caregiver Support.
    2. The elements of this vision that the awardee anticipates 
implementing, including planning activities and assessment of need, if 
not already available.
    3. The work plan and approach, including planning activities and 
assessment of need, if not already available. This work plan should be 
responsive to the most urgent and pressing gaps in availability and 
quality of care and services for persons living with dementia and their 
families. This work plan must include, at the minimum, both the 
provision of clinical services, either directly or through coordination 
with IHS Direct Services, and the engagement of elder services.
    4. The work plan and approach should include developing tools, 
resources, reports, and presentations to support the development of 
programs by other Tribes, Tribal organizations, or Urban Indian health 
    5. If the applicant is the recipient of other HHS grants that will 
provide funding to address dementia over the same time period (e.g. 
Dementia Capability in Indian Country Grant program of the 
Administration for Community Living), indicate how the work plan and 
approach supported through this funding will complement and not 
supplant or overlap that already-funded work.
C. Program Evaluation (30 Points)
    1. Clearly identify plans for program evaluation to ensure that 
objectives of the program are met at the conclusion of the period of 
    2. Include SMART (Specific, Measurable, Achievable, Relevant and 
Time-based) goals to establish a specific set of evaluation criteria to 
ensure the objectives are attainable within the period of performance.
    3. Evaluation should minimally include metrics that provide insight 
into the implementation of those elements of a comprehensive approach 
to care and services for persons living with dementia and their 
families that the applicant has proposed to implement. The evaluation 
should also include metrics for important outcomes of care for persons 
living with dementia and their family, such as avoidance of crisis-
driven care (e.g. emergent transfers and undesired out-of-home 
placement) as well as processes of care that contribute to better 
outcomes (e.g. reduction of medications that impair cognition).
D. Organizational Capabilities, Key Personnel, and Qualifications (20 
    1. Include an organizational capacity statement that demonstrates 
the ability to execute program strategies within the period of 
    2. Project management and staffing plan. Detail that the 
organization has the current staffing and expertise to address each of 
the program activities. If capacity does not exist, please describe the 
applicant's actions to fulfill this gap within a specified timeline.
    3. Identify any partnerships or collaborations that will be needed 
to implement the work plan and include letters of support or intent to 
coordinate or collaborate with those partners.
    4. Demonstrate that the applicant has previous successful 
experience providing technical or programmatic support to Tribal 
E. Categorical Budget and Budget Justification (10 Points)
    1. Provide a detailed budget and accompanying narrative to explain 
the activities being considered and how they are related to proposed 
program objectives.

[[Page 22930]]

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 
     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 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 DCCS 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 
A. The Criteria as Outlined in This Program Announcement
B. Administrative Regulations for Grants
     Uniform Administrative Requirements, Cost Principles, and 
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&
C. Grants Policy
     HHS Grants Policy Statement, Revised January 2007, at 
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 IDC in their application budget. In accordance with HHS Grants 
Policy Statement, Part II-27, the 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 recipients are negotiated with the 
Division of Cost Allocation at https://rates.psc.gov/ or the Department 
of the Interior (Interior

[[Page 22931]]

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 awardee 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 semi-annually. The progress 
reports are due within 30 days after the reporting 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. A final report must be 
submitted within 90 days of expiration of the period of performance.
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.
    Recipients are responsible and accountable for reporting accurate 
information on all required reports: The Progress Reports, the Federal 
Cash Transaction Report, and the Federal Financial Report.
C. Data Collection and Reporting
    The grantee will participate in periodic (not more frequently than 
monthly) web-based calls with the program office or designee and the 
other recipients to share their progress, experience, and tools and 
resource that might be useful for other recipients. The grantee will be 
expected to work with the program office to develop a driver diagram 
(an action-oriented logic model) that describes the comprehensive 
approach to care and services for persons living with dementia and 
their caregivers and identifies key performance metrics based on their 
evaluation plan.
    The grantee will be expected to share, on a semi-annual basis, the 
tools, resources, reports, and presentations produced that may support 
the development of programs by other Tribes, Tribal organizations, or 
Urban Indian health programs.
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. Non-Discrimination Legal Requirements for Recipients of Federal 
Financial Assistance
    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/civil-rights/for-individuals/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 
    The IHS is required to review and consider any information about 
the applicant that is in the FAPIIS, at https://www.fapiis.gov/fapiis/#/home

[[Page 22932]]

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. The 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, Deputy 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]


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 

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: Dr. 
Marcy Ronyak, Director, DCCS, Office of Clinical and Preventive 
Services, Division of Clinical and Community Services, Indian Health 
Service, 5600 Fishers Lane, Mailstop: 08N34-A, Rockville, MD 20857, 
Phone: (301) 443-6458, Fax: (301) 594-6213, Email: 
[email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Donald Gooding, Grants Management Specialist, Indian 
Health Service, Division of Grants Management, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, MD 20857, Phone: (301) 443-2298, Email: 
[email protected].
    3. Questions on systems matters may be directed to: Paul Gettys, 
Deputy 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, 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. 2022-08249 Filed 4-15-22; 8:45 am]