[Federal Register: June 19, 2003 (Volume 68, Number 118)]
[Notices]
[Page 36823-36827]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr19jn03-67]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Elder Health Care Initiative
AGENCY: Indian Health Service, HHS.
ACTION: Notice of availability of funds for competitive grants for
development of long-term care infrastructure for American Indian and
Alaska Native (AI/AN) elders.
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SUMMARY: The Indian Health Service (IHS) announces the availability of
approximately $650,000 for competitive grants established under the
authority of section 301(a) of the Public Health Service Act, as
amended, to Tribal, Urban and non-profit Indian organizations to
support projects that target the development of reimbursable long-term
care services for American Indian and Alaska Native elders. There will
be only one funding cycle during Fiscal Year (FY) 2003 (see Fund
Availability and Period of Support). This program is described at
93.933 in the Catalog of Federal Domestic Assistance. Executive Order
12372 requiring intergovernmental review is not applicable to this
program.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
2010. A copy may be obtained by calling the National Center for Health
Statistics, telephone (301) 443-8500 or at http://www.healthypeople.gov/document
.
Smoke Free Workplace: The PHS strongly encourages all grant
recipients to provide a smoke-free workplace and promote the non-use of
all tobacco products. This is consistent with the PHS mission to
protect and advance the physical and mental health of the American
people.
Due Date: An original and two (2) copies of the completed grant
application must be submitted with all required documentation to the
Grants Management Branch, IHS, 801 Thompson Avenue, Suite 120,
Rockville, MD 20852, by close of business August 1, 2003.
Applications shall be considered as meeting the deadline if they
are either: (1) Received on or before the deadline with hand carried
applications received by close of business 5 p.m.; or (2) postmarked on
or before the deadline date and received in time to be reviewed along
with all other timely applications. A legibly dated receipt from a
commercial carrier or the U.S. Postal Service will be accepted as proof
of timely mailing. Private metered postmarks will not be accepted as
proof of timely mailing. Applications received after the announced
closing date will be returned to the applicant and will not be
considered for funding.
Additional Dates:
A. Application Review Date: August 11--September 2, 2003.
B. Applicants Notified of Results (approved, approved unfunded, or
disapproved): September 15, 2003.
C. Anticipated Start Date: September 15, 2003.
Contacts for Assistance: For program information, contact Bruce
Finke; M.D., Coordinator, IHS Elder Care Initiative, PO Box 467, Zuni,
NM 87327, (505) 782-7357, bfinke@abq.ihs.gov. Techinical Assistance for applicants will be available from the
NICOA Long Term Care Technical Support Center (Dave Baldridge, Program
Director, (505) 292-2001 or dave@nicoa.org).
For grant application and business information, contact Martha
Redhouse, Grants Management Officer, Grants Management Branch, IHS, 801
Thompson Avenue, Suite 120, Rockville, MD 20852, (301) 443-5204. (The
telephone numbers are not toll-free numbers.)
SUPPLEMENTARY INFORMATION: This announcement provides information on
the general program goal, eligibility and documentation requirements,
programmatic activities, funding availability and period of support,
and application procedures.
General Program Goals: The American Indian and Alaska Native elder
population is rapidly growing and the AI/AN population as a whole is
aging. The prevalence of chronic disease in this population continues
to increase, contributing to a frail elder population with increasing
long-term care needs.
The goal of this grant program is to assist Tribes and urban
communities to develop reimbursable or self-financing long-term care
services for their frail elders. The need for these services should be
clearly established based on demographics and the assessment of rates
of functional impairment in the population. The services should be
acceptable to elders and their families and consistent with community
values in their implementation. The services should be part of an
overall vision and plan for a long-term care system to support elders
and their families.
Long-term care can be understood as an array of social and health
care services that support an individual who has needs for assistance
in activities of daily living over a prolonged period. While families
continue to be the backbone of long-term care for AI/AN
[[Page 36824]]
elders, there is an urgent need to develop both services and systems of
care to support families as they care for their elders. The way systems
are developed and implemented can have significant impact on the
cultural and spiritual health of the community. Home and community
based services have been demonstrated to be the most cost efficient
approach to long-term care, have the potential for meeting the needs of
the vast majority of elders requiring long-term care services, and
support the key roles of the family in the care of the elders and the
elder in the care of the family and community.
Tribes and communities have very different histories, capabilities,
and resources with regard to long-term care program development. Thus,
each tribe or community will have different priorities in building an
infrastructure of long term care. The focus of long term care planning
and service delivery is at the tribal and urban community level. An
efficient and effective system of long term care would make use of all
available resources, integrating and coordinating services to assist
families in the care of their elders. A necessary step in that process
is to develop tribally administered and delivered long term care
services.
Applicants are required to demonstrate the sustainability through
ongoing reimbursement or other funding of projects initiated with grant
funds. Applicants are also required to demonstrate how the grant-funded
program integrates into a long-term care for the Tribe and community. A
variety of resources are available to fund Tribal or urban AI/AN long-
term care services. While currently funded IHS services comprise parts
of a long-term care system, the degree to which these resources are
applied to the needs of elders depends both on the local health care
priorities and on the degree of organization of the system to care for
elders. Programs funded through the Administration on Aging (including
the recently funded National Family Caregiver Support Program) have
been key elements in the long-term care infrastructure in Indian
communities. Other resources are available to provide long-term care
services on a reimbursable basis to eligible AI/AN elders. The majority
of long-term care services in this country are funded by Medicaid,
Medicare (limited) and various State-home and community-based care
programs. The Veterans Administration is also a source of reimbursement
for long-term care services for eligible AI/AN Veterans. Federal
housing programs are a potential resource in developing the long-term
care infrastructures. Each of these resources has unique eligibility
requirements.
The Long-Term Care Technical Support Center (Dave Baldridge,
Program Director, (505) 292-2001 or dave@nicoa.org) will be available
to provide consultation and technical support to Tribes and communities
as they develop their grant application.
Eligibility and Documentation Requirements: Any federally
recognized Indian Tribe, Tribal or American Indian/Alaska Native
organization or 501(c)(3) non-profit organizations serving primarily
American Indians and Alaska Natives is eligible to apply for a grant
from the IHS under this announcement. All eligible Tribes, Tribal, or
American Indian/Alaska Native organizations must meet the descriptions
and criteria established to determine non-profit status as specified in
this grant announcement. American Indian and Alaska Native Faith-Based
non-profit organizations are both included and encouraged to apply as
implied in American Indian/Alaska Native organizations as referenced
above.
Documentation of Support
1. Tribal Resolutions.
(a) A resolution of the Indian Tribe or Indian Tribal organization
supporting this specific project must accompany the application
submission.
(b) Applications which propose services which will benefit more
than one Indian Tribe must include resolutions from all affected Tribes
to be served.
(c) Applications by Tribal organizations will not require
resolution(s) if the current Tribal resolution(s) under which they
operate would encompass the proposed grant activities. A statement of
proof or a copy of the current operational resolution must accompany
the application.
(d) If a resolution or a statement is not submitted, the
application will be considered incomplete and will be returned without
consideration.
2. Non-Profit organizations must submit a copy of the 501(c)(3)
certificate, a valid IRS tax exemption certificate or a statement from
a State taxing body certifying applicant organization has a nonprofit
status.
3. Letters of Cooperation/Collaboration/Assistance.
(a) Letters included in the application should be specific to this
program.
(b) If other related human services programs are to be involved in
the project, letters confirming the nature and extent of their
cooperation/collaboration/assistance must be submitted.
Project Types
Eligible projects are those that aim to develop the capacity to
deliver long-term care services at the Tribal or regional level. The
application should describe a comprehensive plan or vision for elder
care services for the community and how the grant proposal will move
toward that vision through program development. Examples include the
establishment of a personal care agency licensed through a state home
and community based care waiver program, establishment of hospice or
home health agency, licensed elder day program, geriatric assessment
(to identify the needs of the frail elder and their family and identify
services which are currently available to meet those needs), case
management to organize, broker, and monitor services, community housing
such as assisted living, board and care or adult foster home.
The proposal should:
1. Include a brief assessment of current resources and programs.
2. Demonstrate how the need for the particular service or program
was identified. If information is not currently available regarding
elder demographics and functional impairment rates, this should be
obtained in the first year of the grant. Additional years of funding
will be contingent on demonstrating this basic demographic information.
3. Show how the project will make use of available funding streams
(Medicaid waivers, personal care options or State-home and community
based care services, VA long-term care benefits, other resources) for
service delivery.
4. Integrate or coordinate with currently available local services
for the elderly (including those available through current IHS funding,
Title VI or Family Caregiver Support funding, Tribal funding, and other
resources). When possible this should be indicated in letters of
support.
5. Demonstrate consistency with cultural values of the community
around the care of the elderly.
6. Build upon the family as the primary source of support for the
elder.
7. Applicants are encouraged to explore novel funding streams to
provide services (e.g., TANF training funds, HUD, USDA programs).
8. The application should include a clear plan for self-sufficiency
through reimbursement or ongoing funding by the end of the grant cycle.
This should
[[Page 36825]]
include agency licensing or certification as required.
9. Tribal match or cost sharing is not required.
Fund Availability and Period of Support: In FY 2003, it is
anticipated that approximately $650,000 will be available to support 20
projects at approximately $30,000 to $50,000 each year for three years,
inclusive of direct and indirect costs. Projects will be funded in
annual budget periods of three years. Continuation of projects
following the initial three-year project will be based upon the
availability of appropriations in future years, the continuing need of
IHS for the projects, and satisfactory project performance. Projects
should not anticipate continued funding past the project period and
should include efforts to become self-sustaining. The anticipated start
date will be September 15, 2003.
The Elder Care Initiative Grant Application Kit: An IHS Grant
Application Kit, including form PHS 5161-1 (rev. 7.00), (OMB Approval
No. 0920-0428) may be obtained from the Grants Management Branch, IHS,
801 Thompson Avenue, Suite 120, Rockville, MD 20852, telephone (301)
443-5204.
Factors for Consideration in Preparing the Application
1. Following the outline provided in the announcement will guide
the writing of the application and facilitate the reviewers in locating
required information.
2. Projects should demonstrate coordination with other agencies and
organizations within and without the community who serve the targeted
population.
3. Indian cultural aspects should be considered in program design.
Application Process: All applications must be single-spaced,
typewritten, and consecutively numbered pages using black type not
smaller than 12 characters per one inch, with conventional one-inch
border margins, on only one side of standard size 8\1/2\ x 11 paper
that can be photocopied. The application Narrative (not including the
Appendix) must not exceed ten typed pages. An additional page may be
used for each additional year of funding requested. Exclusions from the
10-page limit are the Abstract, Tribal Resolution(s), 501(c)(3) non-
profit certificate, valid IRS tax exemption certificate, Letters of
Documentation or Support, Standard Forms, Table of Contents, and the
Appendix. All applications must include the following in the order
presented:
(a) Tribal Resolution(s) and Documentation or 501(c)(3) Certification,
or a copy of the Letters of Cooperation/Collaboration/Assistance
(b) Standard Form 424, Application for Federal Assistance
(c) Standard Form 424A, Budget Information--Non-Construction Programs
(pages 1 and 2)
(d) Standard Form 424B, Assurances--Non-Construction Programs (front
and back)
(e) Checklist (pages 25-26) NOTE: Each standard form and the checklist
is contained in the PHS Grant Application, Form PHS 5161-1 (Rev. 07/00)
(f) A Project Abstract (may not exceed one typewritten page) should
present a summary view of ``who-what-when-where-how-cost'' to determine
acceptability for review
(g) A table of contents to correspond with numbered pages
(h) Project Narrative (10 pages)
(1) Introduction and Need for Assistance
(2) Project Objective(s), Approach, and Results & Benefits
(3) Project Evaluation
(4) Organizational Capabilities and Qualifications
(5) Budget
(i) Proof of Non-Profit status as follows:
1. A reference to the applicant organization's listing in the
Internal Revenue Services: (IRS) most recent list of tax-exempt
organizations described in section (501)(c)(3) of the IRS code.
2. A copy of a currently valid IRS tax exemption certificate.
3. A statement from a State taxing body, State Attorney General, or
other appropriate State official certifying that the applicant
organization has a non-profit status and that none of the net earnings
accrue to any private shareholders or individuals.
4. A certified copy of the organization's certificate of
incorporation or similar document that clearly establishes non-profit
status.
5. Any of the above proof for a State or national parent
organization and a statement signed by the parent organization that the
applicant organization is a local non-profit affiliate.
(j) Appendix to include:
(1) Resumes of key staff
(2) Position description for key staff
(3) Organizational chart
(4) Documentation of current certified financial management systems
(5) Copy of current negotiated indirect cost rate agreement
(6) A map of the area to benefit from the project, and
(7) Application Receipt Card, IHS-815-1A (Rev. 4-97).
(a) Narrative
The narrative section of the application must include the
following: (1) Justification for need for assistance; (2) work plan
(including use of appropriate Native healing practices), program
objectives, approach, expected results and evaluation process, (3)
adequacy of management controls, and (4) key personnel. The work plan
section should be project specific. These instructions for the
preparation of the narrative are to be used in lieu of the instructions
on pages 21-23 of PHS 5161-1. The narrative section should be written
in a manner that is clear to outside reviewers unfamiliar with prior
related activities of the applicant. It should be well organized,
succinct, and contain all information necessary for reviewers to
understand the project fully. The Narrative may not exceed TEN single
spaced pages in length, excluding attachments, budget and Tribal
Resolutions, 5019c)(3) non-profit certificate, and Letters of Support.
(Pages must be numbered.
(b) Need for Assistance
(1) Describe and define the target population at the project
location (e.g. tribal population, number of elders 55 years and older,
percentage and numbers of elders who have functional impairment and are
in need of assistance). Information sources must be appropriately
identified.
(2) Describe the existing resources and services available,
including the maintenance of Native healing systems, where appropriate,
which are related to the specific program/service the applicant is
proposing to provide. Supply the name, address, and phone number of a
contact person for each.
(3) Describe in detail the needs of the target population and what
efforts have been made in the past to meet these needs, if any (e.g.
programs and services currently available to meet the needs of the
frail or functionally impaired elderly).
(4) Summarize the applicable national, IHS, and/or State standards,
laws and regulations, and describe the unmet needs of any applicant's
current program in relation to applicable national, IHS, and/or State
standards, laws and regulations, (e.g. Medicare/Medicaid, third-party
payor reimbursements, Federal/State/Tribal
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laws regarding instituting home health agencies, elder housing, adult
day-care, nursing homes, etc.)
(c) Work Plan
(1) Program Objectives
(i) State concisely the objectives of the project.
(ii) Describe briefly what the project intends to accomplish.
(iii) Describe how accomplishment of the objectives will be
measured (including if replicable).
(2) Approach
(i) Describe the tasks and resources needed to implement and
complete this project.
(ii) Provide a task time line (milestones) breakdown or chart.
Include the date that the project will begin to accept clients.
(3) Describe the Expected Results
(i) Discuss data collection for the project, how it will be
obtained, analyzed, and maintained by the project. Data should include,
but is not limited to, the number and types of clients served, services
provided, client outcomes and satisfaction, and costs associated with
the program.
(ii) Describe how the data collection will support the stated
program objectives and how it will support the program evaluation to
determine the impact of the project.
(4) Program Evaluation
(i) Describe the methods for evaluating program activities,
effectiveness of interventions, success in achieving objectives, the
impact of interventions, acceptance among the targeted population, and
workload accomplishments.
(ii) Identify who will conduct the evaluation of the projected
outcomes and when the evaluation is to be completed.
(iii) Identify the cost of the evaluation (whether internal or
external).
(5) Program Continuance
Discuss how the program services will be sustainable through
ongoing reimbursement or other established funding mechanisms.
(6) Experience Sharing
Indicate the project's willingness to share its program experience
with IHS Areas, urban programs, Tribes and other Tribal organizations.
(d) Adequacy of Management Controls
(1) Describe where the project will be housed, i.e. facilities and
equipment available.
(2) Describe the management controls of the grantee over the
directions and acceptability of work to be performed. Discuss personnel
and financial systems in use and changes planned for this grant.
(3) Applicant must demonstrate that the organization has adequate
systems and expertise to manage Federal funds. Also, include a letter
from the accounting firm describing results of the most recent
organization-wide audit.
(e) Key Personnel
(1) Provide a biographical sketch (qualifications) and position
descriptions for the program director and other key personnel as
described on page 22 of the PHS 5161-1. Identify existing personnel and
new program staff to be hired.
(2) Provide an organizational chart and indicate how the project
will operate within the organization. Describe how this program will
interface with other existing available resources.
(3) List the qualifications and experience of consultants or
contractors where their use is anticipated. Identify who will determine
if the work of a contractor is acceptable.
(f) Budget
(1) An itemized estimate of costs and justification for the
proposed program by line item must be provided on Form SF 424A Budget
Information Non-Construction Programs.
(2) A narrative justification must be submitted for all costs.
Indicate needs by listing individual items and quantities necessary.
The need for items and quantities should be clearly specified in the
narrative justification.
(3) Any special start up costs should be indicated.
(4) Three-Year Projects--Projects requiring three years of funding
must include a brief program narrative and budget for each additional
year of funding requested. The applicant may use one additional page to
describe the developmental plans for each additional year of the
project.
(5) Grant funding may not be used to supplant existing public and
private resources.
(g) Assurances
The application shall contain assurance to the Secretary that the
applicant will comply with program regulations, 42 CFR part 36, Subpart
H.
Review Process: Applications meeting eligibility requirements that
are complete, responsive, and conform to this program announcement will
be reviewed for merit by reviewers appointed by the IHS. The review
will be conducted in accordance with PHS review procedures. The review
process ensures selection of quality projects in a national competition
for limiting funding. Applications will be evaluated and rated on the
basis of the evaluation criteria listed below. These criteria are used
to evaluate the quality of a proposed project, to assign a numerical
score to each application, and to determine the likelihood of its
success. Applications scoring below 60 points will not be funded.
Applications that are acceptable for funding based on scoring will be
ranked. Considerations in ranking include geographic diversity among
funded programs, diversity in population size among Tribes and
communities served by funded programs, and unique features with regard
to type of program planned or population served.
Evaluation Criteria: Applications will be evaluated against the
following criteria and weights:
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Weight Criteria Description
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25%............ 1 Need--The demonstration of identified
problems and risks in the target
population. Extent of community involvement
and commitment. This includes the statement
of the vision or plan for elder care and
the assessment of current resources,
programs, and existing funding streams for
services.
40%............ 2 Work Plan--The soundness and effectiveness
of the applicant's plan for conducting the
project, with special emphasis on the
objectives and methodology portion of the
application. This includes how the proposal
fits the overall plan for long-term care,
how it will make use of existing or novel
funding streams for services, how it is
integrated into the existing service
structure, and the likelihood of achieving
self-sufficiency by the end of the grant
cycle.
15%............ 3 Adequacy of Management Controls--The
apparent capability of the applicant to
successfully conduct the project including
both technical and business aspects. The
soundness of the applicant's budget in
relation to the project work plan and for
assuring effective utilization of grant
funds. Adequacy of facilities and equipment
available within the organization or
proposed for purchase under the project.
10%............ 4 Key Personnel--Qualifications and adequacy
of the key staff.
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10%............ 5 Budget--Clarity and accuracy of program
costs, and cost justification for the
entire grant period.
100% Total Weight
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Reporting Requirements
(1) Progress Report--Program progress reports will be required
semiannually. These reports will include a brief description of a
comparison of actual accomplishments to the goals established for the
period, reasons for slippage and other pertinent information as
required. A final report is due 90 days after expiration of the
project/budget period.
(2) Financial Status Report--A semiannual financial status report
will be submitted 30 days after the end of the half-year. Final
financial status reports are due 90 days after expiration of the
project/budget period. Standard Form 269 (long form) will be used for
financial reporting.
Grant Administration Requirements: Grants are administered in
accordance with the following documents:
(1) 45 CFR Part 92. Department of Health and Human Services,
Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments, or 45 CFR Part 74,
Administration of Grants to Non-profit recipients.
(2) Public Health Service Grants Policy Statement, and
(3) Appropriate Cost Principles: OMB Circular A-87, State and Local
Governments, or OMB Circular A-122, Nonprofit Organizations.
Results of the Review: Successful applicants are notified through
the official Notice of Grant Award (NGA) document. The NGA will state
the amount of Federal funds awarded, the purpose of the grant, the
terms and conditions of the grant award, the effective date of the
award, the project period, and the budget period.
Dated: June 12, 2003.
Charles W. Grim,
Assistant Surgeon General, Interim Director, Indian Health Service.
[FR Doc. 03-15507 Filed 6-18-03; 8:45 am]
BILLING CODE 4160-16-M