Tribal Management Program for American Indians/Alaska Natives: Grants Application Announcement

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Tribal Management Program for American Indians/Alaska Natives:

Grants Application Announcement

AGENCY: Indian Health Service, HHS.

ACTION: Notice of competitive grant applications for tribal management

grants for American Indians/Alaska Natives.

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SUMMARY: The Indian Health Service (IHS) announces that competitive

grant applications are now being accepted for Tribal Management Grants

for American Indians/Alaska Natives. These grants are established under

the authority of section 103(b)(2) and section 103(e) of the Indian

Self-Determination and Education Assistance Act, Pub. L. 93-638, as

amended by Pub. L. 100-472, 25 U.S.C. 450h(b)(2). There will be only

one funding cycle during fiscal year (FY) 1994. This program is

described at 93.228 in the Catalog of Federal Domestic Assistance.

These grants will be awarded and administered in accordance with this

announcement; Department of Health and Human Services regulations

governing Pub. L. 93-638 grants at 42 CFR 36.101 et seq. and 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; the Public Health Service Grant Policy

Statement; and applicable Office of Management and Budget Circulars.

Executive Order 12372 requiring intergovernmental review is not

applicable to this program. Therefore, this program is not subject to

the Public Health System Reporting requirements as referenced in

Executive Order 12372. Public Health Service urges applicants

submitting feasibility studies or health plans to address specific

objectives of Healthy People 2000. Such interested applicants may

obtain a copy of Healthy People 2000 (Summary Report; Stock No. 017-

001-00473-1) through the Superintendent of Documents, Government

Printing Office, Washington, DC 20402-9325 (Telephone 202-783-3238).

DATES: A. Application Receipt Date--An original and two (2) copies of

the completed grant application must be submitted with all required

documentation to the Grants Management Branch, Division of Acquisition

and Grants Operations, Twinbrook Building, suite 300, 12300 Twinbrook

Parkway, Rockville, Maryland 20852, by close of business March 28,

1994.

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 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 in lieu

of a postmark. Private metered postmarks will not be accepted as proof

of timely mailing. Late applications not accepted for processing will

be returned to the applicant and will not be considered for funding.

B. Additional Dates:

1. Application Review: April 25, 1994

2. Applicants Notified of Results: On or about June 17, 1994 (approved,

recommended for approval but not funded, or disapproved)

3. Anticipated Start Date: August 1, 1994.

CONTACTS FOR ASSISTANCE: For Tribal Management Grant program

information, contact Ms. Bea Bowman, Division of Community Services,

Indian Health Service, Parklawn Building, room 6A-05, 5600 Fishers

Lane, Rockville, Maryland 20857, (301) 443-6840. For grant application

and business management information, contact Mrs. Kay Carpentier,

Grants Management Branch, Indian Health Service, Twinbrook Building,

suite 100, 12300 Twinbrook Parkway, Rockville, Maryland 20852, (301)

443-5204. (The telephone numbers are not toll-free.)

SUPPLEMENTARY INFORMATION: This announcement provides information on

the general program purpose, eligibility and documentation, funding

priorities, project types, funds available, limitations, period of

support and application procedures for FY 1994.

A. General Program Purpose

The purpose of the Tribal Management Grant Program is to improve

the management capacity of a tribal organization to enter into a

contract under the Indian Self-Determination Act, Pub. L. 93-638.

Tribal management grants assist tribes and tribal organizations in

preparing to assume operation of all or part of an existing IHS direct

operated health care program by enabling them to develop and maintain

their management capabilities.

In addition, tribal management grants are available to any tribal

organization under the authority of Public Law 93-638 section 103(e)

for (1) obtaining technical assistance from providers designated by the

tribal organization, including tribal organizations that operate mature

contracts, for the purpose of program planning and evaluation,

including the development of any management systems necessary for

contract management, and the development of cost allocation plans for

indirect cost rates; and (2) planning, designing, and evaluating

Federal health programs serving the tribe, including Federal

administrative functions.

Tribal management grants may not be used to support operational

programs, or to supplement existing public and private resources. The

grants may, however, be used as matching shares for other Federal grant

programs that develop tribal capabilities to contract for the

administration and operation of health programs.

Note: Projects related to water, sanitation, waste management;

and long term care; tuition, fees, stipends for certification and

training of staff providing direct services; and design and planning

of construction for facilities will not be considered eligible for

review. Projects which include training and technical assistance on

the pending regulations for Indian Self-Determination and Education

Assistance Act, Pub. L. 93-638, as amended by Pub. L. 100-472, will

not be considered for funding. Inclusion of these activities in a

proposed project shall render the application ineligible and the

application will be returned to the applicant.

B. Eligibility and Documentation

Any federally recognized Indian tribe or Indian tribal organization

is eligible to apply for a grant, however, only one tribal management

grant will be awarded and funded to a tribe or tribal organization per

funding cycle. Eligible applicants include tribal organizations that

operate mature contracts who are designated by a tribe or tribes to

provide technical assistance and/or training.

The following documentation is required:

1. Documentation of new federally recognized/restored tribes--A

copy of the Federal Register Notice of letter from the Bureau of Indian

Affairs (BIA) verifying tribal status.

2. Tribal Resolution--(a) A resolution of the Indian tribe(s)

served by the project must accompany the application; (b) Applications

which propose projects to include more than one Indian tribe must

include resolutions from all tribes to be served; and (c) Applications

by tribal organizations will not require a specific tribal

resolution(s) if the current blanket tribal resolution(s) under which

they operate would encompass the proposed grant activities.

C. Funding Priorities

The IHS has established the following funding priorities for

awarding tribal management grants. Funding priorities were published

for public comment in the Federal Register on November 23, 1992, at 57

FR 54986 and retained with clarification as published on March 12, 1993

at 58 FR 13605.

Priority I

An Indian tribe that has received Federal recognition (new,

restored, unterminated, funded or unfunded) within the past three (3)

years and is preparing to contract under Pub. L. 93-638 to assume

operation of health care services.

Priority II

An Indian tribe or Indian tribal organization currently contracting

with IHS, with a stated intention to contract all or part of an

existing IHS operated service unit or health program. Applicants

meeting this profile must have current certified management systems,

i.e. BIA, IHS, or CPA certified; and resolutions of support from the

tribes to be served by the project in a multi-tribal service unit.

Priority III

An Indian tribe or Indian tribal organization stating an interest

in contracting IHS health programs for the first time. Applicants

meeting this profile must have current certified management systems,

i.e. BIA, IHS, or CPA certified; or respond within a specific time

period in the first quarter of the grant period to establish certified

management systems to begin receiving federal funds.

Priority IV

An Indian tribe or Indian tribal organization stating an interest

in planning, designing and evaluating Federal health programs serving

the tribe, including Federal administrative functions.

Priority V

An Indian tribe or Indian tribal organization currently contracting

IHS tribal programs, i.e., Community Health Representative program,

Alcohol programs, Emergency Medical Services, etc., and are seeking

improvement or expansion of existing tribal health management structure

without further contracting.

D. Project Types

The Tribal Management Grant Program consists of seven (7) types of

projects: (1) Feasibility studies, (2) planning, (3) development of

tribal health management structure, (4) human resources development,

(5) evaluation, (6) technical assistance and (7) Federal programs

analysis.

Note: The above listing of project types are not subject to

prioritization.

Applications shall address only one project type as opposed to a

combination of two or more project types.

Project Types Descriptions

1. Feasibility Study--a study of a specific IHS program or segment

of a program to determine if tribal management of the program is

possible. This study shall indicate necessary plans, approach, training

and resources required to assume tribal management of the program. The

study shall include a minimum of four (4) major components:

a. Health needs and health care services assessments, which

identify existing health care services and delivery system, program

division issues, health status indicators, unmet needs, volume

projections, and demand analysis.

b. Management analysis of existing management structure, proposed

management structure, implementation plans and requirements, and

personnel staffing requirements and recruitment barriers.

c. Financial analysis of historical trends data, financial

projections and new resource requirements for program and management

costs, and analysis of potential revenues from Federal/Non-Federal

sources.

d. Decision stage which incorporates findings; conclusions and

recommendations; and presentation of the feasibility study and

recommendations to the governing body to determine whether tribal

assumption of the health program(s) is desirable or warranted.

2. Plan--a collection of data to establish goals, policies, and

procedures for operation of tribal health programs. Health plans shall

specify IHS health programs and the priority order in which the tribe

will assume operation of these programs. A plan shall include a minimum

of four components:

a. Survey and analysis of the population's needs.

b. Prioritization of health needs and programs.

c. Statement of goals and objectives for each program to be

assumed.

d. Strategy including policies and procedures for tribal assumption

and operation of each program.

3. Development of Tribal Health Management Structure--creation or

enhancement and implementation of systems to manage, organize or direct

health programs. Management structures include health department

structure and organization, tribal health boards, systems for

accounting, personnel, third party billing, medical records, etc.,

upgrading to achieve accreditation through Joint Commission on

Accreditation of Health Organizations (JCAHO) or development of fiscal

and patient registration systems to meet requirements of Federally

Qualified Health Centers (FQHC). Management structure projects shall

include at minimum the following:

a. Description of existing structures.

b. Explanation of the purpose and design of the proposed management

structure.

c. Identification of improvements expected and impact of newly

created or enhanced management structure proposed.

d. Short range and long range strategies for tribal operation of

the management structure.

4. Human Resources Development--development of a particular skill

or group of skills required for tribal staff to manage or operate an

IHS program. The human resources development plan shall at minimum

include:

a. Training needs assessment and analysis of education, skills and

experience of current staff and future requirements.

b. Assessment of management and administrative competence required

to meet short range (1-2 years) and long range (not more than 5 years)

needs coupled with identification of organizational needs.

c. Identification of short range and long range management training

program.

5. Evaluation Studies--a systematic collection, analysis, and

interpretation of data to determine the value of current tribal health

programs. Evaluation studies shall at minimum include:

a. Effects of any previous studies as related to the goals and

objectives, policies and procedures, or programs on target groups.

b. A description of the current tribal health programs'

effectiveness and efficiency, including direct services, financial

management, personnel, data collection and analysis, third party

billing, etc.

c. Identification of what could be done to improve the health care

delivery system(s).

6. Technical Assistance--aid or help from providers designated by

the tribal organization, including tribal organizations that operate

mature contracts, for the purposes of program planning and evaluation,

including development of any management systems necessary for contract

management, and development of cost allocation plans for indirect cost

rates. For example, an Indian tribe or Indian organization may wish to

seek technical assistance from a tribe to develop a managed care

component for a direct service delivery system.

7. Federal Programs Analysis--projects focused on planning,

designing and evaluating Federal programs serving the tribe, including

Federal administrative functions. For example a tribe or tribal

organization may wish to evaluate IHS direct services programs such as

Contract Health Services, Mental Health, Public Health Nursing, etc.

E. Funds Available, Limitations and Period of Support

1. Funds available--It is anticipated that approximately $5,000,000

will be available for approximately 75 new and continuation grants

averaging $67,000 each. Grant funding levels include both direct and

indirect costs.

2. Limitations--Only one grant project will be awarded per tribe or

tribal organization. A current tribal management grantee whose project

will not be completed within the current grant period will not be

awarded new, renewal or competing continuation grants.

3. Period of support--(a) feasibility studies and planning projects

are limited to one year (12 months) funding; (b) projects regarding

tribal management structure, human resources development, evaluation,

technical assistance, and Federal programs analysis may be funded up to

three (3) years in annual budget periods depending upon the defined

scope of work.

F. The Tribal Management Grant Application Kit

A Tribal Management Application Kit, including the required PHS

form and Narrative PHS 5161-1 (Rev. 7/92) (OMB Approval No. 0937-0189)

and the U.S. Government Standard forms (SF-424, SF-424A and SF-424B),

may be obtained from the Grants Management Branch, Division of

Acquisition and Grants Operations, IHS, Twinbrook Metro Plaza, suite

100, 12300 Twinbrook Parkway, Rockville, MD 20852, telephone (301) 443-

5204. (Note: This is not a toll free number.)

G. Grant Application Requirements

All applications must be singled-spaced, typewritten, and

consecutively numbered pages using black type not smaller than 12

characters per one inch, with conventional border margins, on only one

side of standard size 8\1\/\2\ x 11 paper that can be photocopied.

All applications must include the following in the order presented:

--Tribal Resolution(s) and Documentation (B. Eligibility and

Documentation),

--Standard Form 424, Application for Federal Assistance,

--Standard Form 424A, Budget Information--Non-Construction Programs,

(pages 1 and 2),

--Standard form 424B, Assurances--Non-Construction Programs (front and

back),

--Checklist (pages 23-24) Note: Each standard form and the checklist is

contained in the PHS Grant Application, Form PHS 5161-1 (Revised 7/92),

--A one-page project abstract (H. 1.),

--A table of contents (H. 2.),

--Introduction (H. 3.),

--Need for Assistance (H. 4.),

--Objective(s), Results, and Benefits Expected (H. 5),

--Approach (H. 6.),

--Evaluation (H. 7),

--Key Personnel (H. 8.),

--Budget Justification and Management Controls (H. 9), and

--Appendix to include:

*Resumes (Curriculum Vitae) of key staff,

*Position descriptions for key staff,

*Organizational chart,

*Copy of current negotiated indirect cost rate agreement,

*A map of the area to benefit from the project,

*A copy of the survey instrument, if used.

*Application Receipt Card, PHS--3038-1 Rev. 5-90.

H. Application Narrative Instructions, Application Standards (Criteria)

and Weights

The following instructions for preparing the application narrative

also constitute the standards (criteria or basis for evalaution) for

reviewing the application to approve or disapprove. Weights assigned

each section are noted in parenthesis.

1. Abstract--An abstract may not exceed one typewritten page. The

abstract should clearly present the application in summary form, from a

``who-what-when-where-how-cost'' point of view so that reviewers see

how the multiple parts of the application fit together to form a

coherent whole.

2. Table of Contents--Provide a one page typewritten table of

contents.

Narrative: Please describe the complete project in clear and

succinct language as application reviewers may have little or no

knowledge regarding the tribe or tribal organization. It should be

organized as described in this section, should not exceed 25 single

spaced pages, and address the following: (Note: Application narratives

exceeding 25 pages will not be accepted for review.)

3. Introduction (5 pts.)

a. Identify the funding priority and justify the priority selected.

b. Identify the type of project.

c. State the type (specific or blanket) and date of resolution

submitted with the application. (Refer to B. Eligibility and

Documentation).

d. Describe the population to be served by management of tribal

health programs and the number of eligible beneficiaries.

e. Provide a precise location of the project and area to be served

by the proposed project including a map (include the map in the

appendix).

4. Need for Assistance (10 pts.)

a. Explain the reason for the project.

b. Describe the tribe's current health operations including whether

the tribe has a health department, how long it has been operating, what

programs or services are currently provided and indicate

accomplishments using statistics if available.

c. Describe the overall and specific need for assistance by

explaining the current and past situation or demand and unmet need

(i.e., resources, staffing, equipment, training, etc.).

d. Identify relevant environmental, economic, social, financial or

organizational programs requiring solutions.

e. Include relevant statistical data to support the need and

include examples.

f. Describe the relationship between this project and other

federally funded work planned, anticipated, or underway.

g. Identify all previous and/or current tribal management grants

received, dates of funding, and project accomplishments (Do not include

copies of reports).

5. Objective(s) Results and Benefits Expected (20 pts.)

a. State is measurable terms, realistic principal and subordinate

objectives of the project.

b. Identify the expected results, benefits and outcome or product

to be derived from each objective of the project.

c. Identify who will do what, when, and how, relating to the

anticipated outcome of the project.

6. Approach (20 pts.)

a. Outline and describe the major tasks and activities with the

objective(s) to be achieved.

b. Include a workplan with start, target milestones and completion

dates on a calendar timeline.

c. Discuss present or proposed staffing of the project. Position

descriptions for key personnel must be included in the Appendix.

d. Describe data sources, management, quality control, and analysis

by addressing:

1. Data to be collected, by whom, and time intervals in the

project,

2. Data sources and how access to the sources will be attained,

3. Procedure to collect, receive, code and prepare the data for

analysis,

4. How data will be kept confidential and secure,

5. Contingency plan for low response rates,

6. How completeness and accuracy of data will be measured and

assured.

7. Plan for statistical or non-statistical analyses of data,

8. Include a copy of survey instrument(s), if used.

e. If use of consultants or contractors is proposed or anticipated,

provide a detailed scope of work which clearly defines the deliverable

or outcomes anticipated; and qualifications and experience

requirements.

f. Identify who will review and accept the work products of the

project deliverable/outcomes, including work to be performed by

consultants or contractors.

7. Evaluation (15 pts.)

a. State how it will be determined if the project's objectives were

achieved and how the accomplishment of those objectives can be

attributed to the project.

b. Discuss the criteria to be used to evaluate results and

benefits.

c. Explain the methodology that will be used to determine if the

needs identified for the project are being met and if the project's

outcomes identified are being achieved.

8. Key Personnel (15 pts.)

a. Provide job position descriptions and resumes (if applicable)

for key staff.

b. Identify qualifications and experience requirements for

consultants or contractors if use is anticipated.

c. State the tribe's approved Indian Preference policy.

9. Budget Justification and Management Control (15 pts.)

a. Provide a budget justification in accordance with the budget

narrative instructions contained on page 21 of form PHS 5161-1

b. Describe where the project will be housed, i.e., facilities and

equipment available.

c. List equipment and software purchases necessary for

implementation of the project; include descriptive rationale and

justification for computer hardware/software.

d. Describe the management control of the tribe/tribal organization

over the direction and acceptability of work to be performed by the

consultant or contractor.

e. Provide documentation of current certified financial management

system, i.e. BIA, IHS, or CPA certified.

f. If a first-time applicant, include a plan to meet the special

requirement of establishing certified management systems to begin

receiving Federal funds.

g. If indirect cost are claimed, applicant must submit a copy of

Indirect Cost Rate Agreement supporting this claim.

10. Multi-year Projects--projects requiring a second or third year

must include a program narrative and categorical budget and

justification for each additional year of funding requested.

11. Appendix--to include:

a. Current approved organizational chart,

b. Resumes and job descriptions for key staff,

c. Copy of current negotiated indirect cost rate agreement,

d. A map of the area to benefit from the project,

e. A copy of the survey instrument, if used, and

f. Application receipt card, PHS 3038-1 Rev. 5-90.

I. Assurances

The application shall contain assurances to the Secretary that the

applicant will comply with program regulations, 42 CFR part 36 subpart

H.

J. Reporting

1. Program Report--Program progress reports will be submitted

quarterly. 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 budget/

project period.

2. Financial Status Report--Quarterly financial status reports will

be submitted 30 days after the end of the quarter. Final financial

status reports are due 90 days after expiration of the budget/project

period. Standard Form 269 (long form) will be used for financial

reporting.

K. 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 Grant Policy Statement, and

3. Appropriate Cost principles: OMB Circular A-87, State and Local

Governments, or OMB Circular A-122, Non-profit Organizations.

L. Objective Review Process

Applications meeting eligibility requirements that are complete and

conform to this program announcement will be reviewed by a centralized

Ad Hoc Objective Review Committee (ORC) appointed by IHS primarily for

review of these applications. The review will be conducted at the IHS

Headquarters and in accordance with IHS objective review procedures.

The objective review process ensures nationwide competition for limited

funding. The ORC will be comprised of IHS (40% or less) and other

federal or non-federal individuals (60% or more) with appropriate

expertise. The ORC will review each application against established

criteria. Based upon the evaluation criteria, the reviewers assign a

numerical score to each application, which will be used in making the

final funding decision. Applications scoring less than 60 points will

be considered technically unacceptable and will be disapproved.

M. Application Standards Qualitative Rating Factors

1.0=Excellent--very comprehensive, in-depth clear response. The

application meets this standard with no omissions. Consistently high

performance can be expected.

0.8=Very Good--extensive, detailed application similar to excellent

in quality, but with minor areas requiring additional clarification.

High quality performance is likely, but not assured due to minor

omissions or areas where less than excellent performance might be

expected.

0.6=Good--no deficiencies in the response. Better than acceptable

performance can be expected, but in some significant area there is lack

of clarity which might impact on performance.

0.4=Fair--the response generally meets minimum standards. Existing

deficiencies are confined to areas with minor impact on performance and

can be corrected without revision.

0.2=Marginal--deficiencies exist in significant areas. The

application can be corrected without major revision or serious

deficiencies exist in areas with minor impact.

0.0=Unsatisfactory--serious deficiencies exist in significant

areas. The project cannot be expected to meet minimum requirements

without revisions. The application only indicates a willingness to

perform a project without specifying how or demonstrating the capacity

to do so. Only vague indications exist regarding capability.

N. Results of the Review

The results of the objective Review are forwarded to the Associate

Director, Office of Tribal Activities, for final review and approval.

Applicants are notified of their approval or approval without funds, on

or about June 17, 1994. A Notice of Grant Award will be issued

approximately ten (10) days prior to the start date of August 1, 1994.

Unsuccessful applicants are notified in writing of disapproval not

later than June 17, 1994. A brief explanation of the reasons the

application was not approved is provided along with the name of an IHS

official to contact if more information is desired.

Dated: December 10, 1993.

Michel E. Lincoln,

Acting Director.

[FR Doc. 94-3009 Filed 2-9-94; 8:45 am]

BILLING CODE 4160-16-M