Office of Urban Indian Health Programs Proposed Single Source Grant With Native American Lifelines, Inc., 48441-48454 [2013-19113]
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[FR Doc. 2013–19112 Filed 8–7–13; 8:45 am]
BILLING CODE 4165–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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Indian Health Service
Office of Urban Indian Health
Programs Proposed Single Source
Grant With Native American Lifelines,
Inc.
Funding Announcement Number:
HHS–2013–IHS–UIHP–0002.
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Catalogue of Federal Domestic
Assistance Number: 93.193.
Key Dates
Application Deadline Date: August
26, 2013.
Review Period: August 28, 2013.
Earliest Anticipated Start Date:
September 1, 2013.
I. Funding Opportunity Description
Statutory Authority
The Indian Health Service (IHS),
Office of Urban Indian Health Programs
(OUIHP), announces the FY 2013 single
source competing grant for operation
support for the 4-in-1 Title V grant to
make health care services more
accessible for American Indians and
Alaska Natives (AI/AN) residing in the
Boston metropolitan area. This program
is authorized under the authority of the
Snyder Act, 25 U.S.C. 13, and the Indian
Health Care Improvement Act (IHCIA),
as amended, 25 U.S.C. 1652, 1653,
1660a. This program is described at
93.193 in the Catalog of Federal
Domestic Assistance (CFDA).
Purpose
Under this grant opportunity, the IHS
proposes to award a single source grant
to Native American Lifelines, Inc.,
which is an urban Indian organization
that has an existing IHS contract, in
accordance with 25 U.S.C. 1653(c)–(f),
1660a, in the Boston metropolitan area.
This grant announcement seeks to
ensure the highest possible health status
for urban Indians. Funding will be used
to establish the urban Indian
organization’s successful
implementation of the priorities of the
Department of Health and Human
Services (HHS), Strategic Plan Fiscal
Years 2010–2015, Healthy People 2020,
and the IHS Strategic Plan 2006–2011.
Additionally, funding will be utilized to
meet objectives for Government
Performance Rating Act (GPRA)
reporting, collaborative activities with
the Veterans Health Administration
(VA), and four health programs that
make health services more accessible to
urban Indians. The four health services
programs are: (1) Health Promotion/
Disease Prevention (HP/DP) services, (2)
Immunizations, (3) Behavioral Health
Services consisting of Alcohol/
Substance Abuse services, and (4)
Mental Health Prevention and
Treatment services. These programs are
integral components of the IHS
improvement in patient care initiative
and the strategic objectives focused on
improving safety, quality, affordability,
and accessibility of health care.
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48441
Single Source Justification
Native American Lifelines, Inc. is
identified as the single source for this
award, based on the following criteria:
1. As required by law, the grants
authorized by 25 U.S.C. 1653(c)–(f),
1660a may only be awarded to those
urban Indian organizations that have a
current contract with the IHS to provide
health care to urban Indians, in the
urban center identified in the contract.
2. Native American Lifelines is the
urban Indian organization IHS currently
contracts with to provide health care
and referral services to urban Indians
residing in the Boston area.
Native American Lifelines, Inc. is
uniquely qualified to receive this award
and provide the identified program
activities based on their history with the
urban Indian health programs, and their
knowledge of urban Indian health and
the Boston target population. The
program is licensed by the state as a
behavioral health provider; all of the
staff operating at the facility are licensed
and credential in their respective fields
(specifically behavioral health); and
they use evidence-based behavioral
health assessment and treatment
strategies with success. The program
successfully uses targeted outreach and
comprehensive case management
services for clients in the community.
Through this outreach and case
management, the program has expanded
offering to include on-site dental service
and transportation. Also, the program
has been successful in entering into
collaborative agreements with
community health resources for the
provision of quality and comprehensive
health care for clients. In support of
these successful activities, the Board of
Directors is active in the program and
committed to bringing quality health
care to the urban Indians of the Boston
metropolitan area.
II. Award Information
Type of Awards
Grant.
Estimated Funds Available
The total amount of funding
identified for the current fiscal year (FY)
2013 is $153,126. Any awards issued
under this announcement are subject to
the availability of funds. In the absence
of funding, the Agency is under no
obligation to make awards funded under
this announcement.
Anticipated Number of Awards
One single source award will be
issued under this program
announcement.
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Project Period
The project periods for this award
will be as follows:
Year One: Six Months Budget Period
from September 1, 2013 to March 31,
2014.
Year Two: Twelve Months Budget
Period from—April 1, 2014 to March 31,
2015.
Year Three: Twelve Months Budget
Period from—April 1, 2015 to March 31,
2016.
IIII. Application and Submission
Information
1. Obtaining Application Materials
The application package and detailed
instructions for this announcement can
be found at https://www.Grants.gov or
https://www.ihs.gov/dgm/
index.cfm?module=dsp_dgm_funding.
Questions regarding the electronic
application process may be directed to
Mr. Paul Gettys at (301) 443–2114.
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2. Content and Form Application
Submission
The applicant must include the
project narrative as an attachment to the
application package. Mandatory
documents for all applicants include:
• Table of contents.
• Abstract (one page) summarizing the
project.
• Application forms:
Æ SF–424, Application for Federal
Assistance.
Æ SF–424A, Budget Information—
Non-Construction Programs.
Æ SF–424B, Assurances—NonConstruction Programs.
• Budget Justification and Narrative
(must be single-spaced and not
exceed five pages).
• Project Narrative (must be single
spaced and not exceed ten pages).
Æ Background information on the
organization.
Æ Proposed scope of work, objectives,
and activities that provide a
description of what will be
accomplished, including a one-page
Timeframe Chart.
• 501(c)(3) Certificate.
• Disclosure of Lobbying Activities (SF–
LLL).
• Certification Regarding Lobbying (GGLobbying Form).
• Copy of current Negotiated Indirect
Cost rate (IDC) agreement (required)
in order to receive IDC.
• Documentation of current OMB A–
133 required Financial Audit (if
applicable).
Acceptable forms of documentation
include:
Æ Email confirmation from Federal
Audit Clearinghouse (FAC) that
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audits were submitted; or
Æ Face sheets from audit reports.
These can be found on the FAC
Web site: https://harvester.
census.gov/sac/dissem/
accessoptions.html?submit=Go+To
+Database.
Public Policy Requirements
All Federal-wide public policies
apply to IHS grants with exception of
the Discrimination policy.
Requirements for Project and Budget
Narratives
A. Project Narrative: This narrative
should be a separate Word document
that is no longer than ten pages and
must: be single-spaced, be typewritten,
have consecutively numbered pages, use
black type not smaller than 12
characters per one inch, and be printed
on one side only of standard size 81⁄2″
× 11″ paper. These narratives will assist
the Objective Review Committee (ORC)
in becoming more familiar with the
grantee’s activities and
accomplishments prior to this possible
grant award. If the narrative exceeds the
page limit, only the first ten pages will
be reviewed. The 10-page limit for the
narrative does not include the work
plan, standard forms, table of contents,
budget, budget justifications, narratives,
and/or other appendix items.
B. Budget Narrative: This narrative
must describe the budget requested and
match the scope of work described in
the project narrative. The budget
narrative should not exceed five pages.
3. Submission Dates and Times
Applications must be submitted
electronically through Grants.gov by
12:00 a.m., midnight Eastern Daylight
Time (EDT) on the Application Deadline
Date listed in the Key Dates section on
page one of this announcement. Any
application received after the
application deadline will not be
accepted for processing, nor will it be
given further consideration for funding.
The applicant will be notified by the
Division of Grants Management (DGM)
via email of this decision.
If technical challenges arise and
assistance is required with the
electronic application process, contact
Grants.gov Customer Support via email
to support@grants.gov or at (800) 518–
4726. Customer Support is available to
address questions 24 hours a day, 7 days
a week (except on Federal holidays). If
problems persist, contact Mr. Paul
Gettys, DGM (Paul.Gettys@ihs.gov) at
(301) 443–2114. Please be sure to
contact Mr. Gettys at least ten days prior
to the application deadline. Please do
not contact the DGM until you have
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received a Grants.gov tracking number.
In the event you are not able to obtain
a tracking number, call the DGM as soon
as possible.
If the applicant needs to submit a
paper application instead of submitting
electronically via Grants.gov, prior
approval must be requested and
obtained (see Section IV.6 below for
additional information). The waiver
must be documented in writing (emails
are acceptable), before submitting a
paper application. A copy of the written
approval must be submitted with the
hardcopy that is mailed to the DGM.
Once the waiver request has been
approved, the applicant will receive a
confirmation of approval and the
mailing address to submit the
application. Paper applications that are
submitted without a waiver from the
Acting Director of DGM will not be
reviewed or considered further for
funding. The applicant will be notified
via email of this decision by the Grants
Management Officer of DGM. Paper
applications must be received by the
DGM no later than 5:00 p.m., EST, on
the Application Deadline Date listed in
the Key Dates section on page one of
this announcement. Late applications
will not be accepted for processing or
considered for funding.
4. Intergovernmental Review
Executive Order 12372 requiring
intergovernmental review is not
applicable to this program.
5. Funding Restrictions
• Pre-award costs are not allowable.
• The available funds are inclusive of
direct and appropriate indirect costs.
• IHS will not acknowledge receipt of
applications.
6. Electronic Submission Requirements
All applications must be submitted
electronically. Please use the https://
www.Grants.gov Web site to submit an
application electronically and select the
‘‘Find Grant Opportunities’’ link on the
homepage. Download a copy of the
application package, complete it offline,
and then upload and submit the
completed application via the https://
www.Grants.gov Web site. Electronic
copies of the application may not be
submitted as attachments to email
messages addressed to IHS employees or
offices.
If the applicant receives a waiver to
submit paper application documents,
the applicant must follow the rules and
timelines that are noted below. The
applicant must seek assistance at least
ten days prior to the Application
Deadline Date listed in the Key Dates
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section on page one of this
announcement.
Applicants that do not adhere to the
timelines for System for Award
Management (SAM) and/or https://
www.Grants.gov registration or that fail
to request timely assistance with
technical issues will not be considered
for a waiver to submit a paper
application.
Please be aware of the following:
• Please search for the application
package in https://www.Grants.gov by
entering the CFDA number or the
Funding Opportunity Number. Both
numbers are located in the header of
this announcement.
• If technical challenges are
experienced while submitting the
application electronically, please
contact Grants.gov Support directly at:
support@grants.gov or (800) 518–4726.
Customer Support is available to
address questions 24 hours a day, 7 days
a week (except on Federal holidays).
• Upon contacting Grants.gov, obtain
a tracking number as proof of contact.
The tracking number is helpful if there
are technical issues that cannot be
resolved and waiver from the agency
must be obtained.
• If it is determined that a waiver is
needed, the applicant must submit a
request in writing (emails are
acceptable) to GrantsPolicy@ihs.gov
with a copy to Tammy.Bagley@ihs.gov.
Please include a clear justification for
the need to deviate from the standard
electronic submission process.
• If the waiver is approved, the
application should be sent directly to
the DGM by the Application Deadline
Date listed in the Key Dates section on
page one of this announcement.
• An applicant is strongly encouraged
not to wait until the deadline date to
begin the application process through
Grants.gov as the registration process for
SAM and Grants.gov could take up to
fifteen working days.
• Please use the optional attachment
feature in Grants.gov to attach
additional documentation that may be
requested by the DGM.
• An applicant must comply with any
page limitation requirements described
in this Funding Announcement.
• After electronically submitting the
application, the applicant will receive
an automatic acknowledgment from
Grants.gov that contains a Grants.gov
tracking number. The DGM will
download the application from
Grants.gov and provide necessary copies
to the appropriate agency officials.
Neither the DGM nor the OCPS will
notify the applicant that the application
has been received.
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• Email applications will not be
accepted under this announcement.
Dun and Bradstreet (D&B) Data
Universal Numbering System (DUNS)
All IHS applicants and grantee
organizations are required to obtain a
DUNS number and maintain an active
registration in the SAM database. The
DUNS number is a unique 9-digit
identification number provided by D&B
which uniquely identifies each entity.
The DUNS number is site specific;
therefore, each distinct performance site
may be assigned a DUNS number.
Obtaining a DUNS number is easy, and
there is no charge. To obtain a DUNS
number, please access it through
https://fedgov.dnb.com/webform, or to
expedite the process, call (866) 705–
5711.
All HHS recipients are required by the
Federal Funding Accountability and
Transparency Act of 2006, as amended
(‘‘Transparency Act’’), to report
information on subawards. Accordingly,
all IHS grantees must notify potential
first-tier subrecipients that no entity
may receive a first-tier subaward unless
the entity has provided its DUNS
number to the prime grantee
organization. This requirement ensures
the use of a universal identifier to
enhance the quality of information
available to the public pursuant to the
‘‘Transparency Act.’’
System for Award Management (SAM)
Organizations that were not registered
with Central Contractor Registration
(CCR) and have not registered with SAM
will need to obtain a DUNS number first
and then access the SAM online
registration through the SAM home page
at https://www.sam.gov (U.S.
organizations will also need to provide
an Employer Identification Number
from the Internal Revenue Service that
may take an additional 2–5 weeks to
become active). Completing and
submitting the registration takes
approximately one hour to complete
and SAM registration will take 3–5
business days to process. Registration
with the SAM is free of charge.
Applicants may register online at
https://www.sam.gov.
Additional information on
implementing the ‘‘Transparency Act,’’
including the specific requirements for
DUNS and SAM, can be found on the
IHS Grants Management, Grants Policy
Web site: https://www.ihs.gov/dgm/
index.cfm?module=dsp_dgm_policy_
topics.
IV. Application Review Information
The instructions for preparing the
application narrative also constitute the
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evaluation criteria for reviewing and
scoring the application. Weights
assigned to each section are noted in
parentheses. The 10-page narrative
should include only the first year of
activities; information for multi-year
projects should be included as an
appendix. See ‘‘Multi-year Project
Requirements’’ at the end of this section
for more information. The narrative
section should be written in a manner
that is clear to outside reviewers
unfamiliar with prior related activities
of the applicant. It should be well
organized, succinct, and contain all
information necessary for reviewers to
understand the project fully. Points will
be assigned to each evaluation criteria
adding up to a total of 100 points. A
minimum score of 75 points is required
for approval and funding. Points are
assigned as follows:
1. Criteria
The instructions for preparing the
application narrative also constitute the
evaluation criteria for reviewing the
application.
The narrative should address program
progress for the seven months budget
period activities, September 1, 2013
through March 31, 2014.
The narrative should be written in a
manner that is clear to outside reviewers
unfamiliar with prior related activities
of the urban Indian health programs
(UIHP). It should be well organized,
succinct, and contain all information
necessary for reviewers to fully
understand the project.
Points assigned for the criteria are as
follows:
• UNDERSTANDING OF THE NEED
AND NECESSARY CAPACITY (30
Points)
• WORK PLANS (40 Points)
• PROJECT EVALUATION (15 Points)
• ORGANIZATIONAL CAPABILITIES
AND QUALIFICATIONS (10 Points)
• CATEGORICAL BUDGET AND
BUDGET JUSTIFICATION (5 Points)
A. PROJECT NARRATIVE:
UNDERSTANDING OF THE NEED AND
NECESSARY CAPACITY (30 points)
1. Facility Capability:
The UIHPs provide health care
services within the context of the HHS
Strategic Plan, Fiscal Years 2010–2015;
the IHS Strategic Plan 2006–2011, and
four IHS priorities.
Describe the UIHP: Define activities
planned for the 2013 budget period
September 1, 2013—March 31, 2014
budget period in each of the following
areas:
(a) IHS Priorities for American Indian/
Alaska Native Health Care Current
governmental trends and environmental
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issues impact urban Indians and require
clear and consistent support by the IHS
funded UIHP. The IHS Web site is
https://www.ihs.gov.
(1) Renew and Strengthen
Partnerships with Tribes and the UIHPs:
The UIHPs have a hybrid relationship
with the IHS. With the passage of Public
Law 111–148, the Indian Health Care
Improvement Act was made permanent.
• Identify what the UIHP is doing to
strengthen its partnerships with Tribes
and other UIHPs.
(a) September 1, 2013—March 31,
2014 activities planned, including
information on how results are shared
with the community.
(b) List the top ten Tribes whose
members are seen by the program.
2. Bring Health Care Reform to the
UIHPs: In order to support health care
reform, it must be demonstrated there is
a willingness to change and improve,
i.e., in human resources and business
practices.
• Describe activities the UIHP is
taking to ensure health care reform is
being implemented.
(a) September 1, 2013—March 31,
2014 activities planned.
3. Improve the Quality of and Access
to Care: Customer service is the key to
quality care. Treating patients well is
the first step to improving quality and
access. This area also incorporates Best
Practices in customer service.
• Identify activities that demonstrate
the UIHP is improving quality of and
access to care.
(a) September 1, 2013—March 31,
2014 activities planned.
4. Ensure all UIHP work is
Transparent, Accountable, Fair, and
Inclusive: Quality health care needs to
be transparent, with all parties held
accountable for that care. Accountability
for services is emphasized.
• Describe activities that demonstrate
how this is implemented in the UIHP
program.
(a) September 1, 2013—March 31,
2014 activities planned.
5. HHS Priorities for Health Care:
Current governmental trends and
environmental issues impact urban
Indians and require clear and consistent
support by the IHS funded UIHP.
(a) Health Care Value Incentives: The
growth of health care costs is restrained
because consumers know the
comparative costs and quality of their
health care—and they have a financial
incentive to care.
• Identify what the UIHP is doing to
help its consumers gain control of their
health care and have the knowledge to
make informed health care decisions.
(1) September 1, 2013—March 31,
2014 activities planned, including
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information on how clinical quality data
is shared with consumers and the
community.
6. Health Information Technology:
Secure interoperable electronic records
are available to patients and their
doctors anytime, anywhere.
• Describe Resource Patient
Management Systems (RPMS)/
Electronic Health Record (EHR) or nonRPMS activities the UIHP is taking to
ensure immediate access to accurate
information to reduce dangerous
medical errors and help control health
care costs.
(a) September 1, 2013-March 31, 2014
activities planned.
7. Medicare Rx: Every senior has
access to affordable prescription drugs.
Consumers will inspire plans to provide
better benefits at lower costs. Medicare
Part D is streamlined and improved to
better connect people with their
benefits. Pay for Performance
methodologies act to increase health
care quality.
• Identify activities the UIHP is
taking to implement Medicare Rx.
(a) September 1, 2013—March 31,
2014 activities planned.
8. Personalized Health Care: Health
care is tailored to the individual.
Prevention and wellness is emphasized.
Propensities for disease are identified
and addressed through preemptive
intervention.
• Describe activities that demonstrate
how this is implemented in the UIHP
program.
(a) September 1, 2013—March 31,
2014 activities planned.
9. Obesity Prevention: The risk of
many diseases and health conditions are
reduced through actions that prevent
obesity. A culture of wellness deters or
diminishes debilitating and costly
health events. Individual health care is
built on a foundation of responsibility
for personal wellness.
• Describe activities that demonstrate
how the UIHP program is implementing
this priority.
(a) September 1, 2013—December 31,
2014 activities planned.
10. Tobacco Cessation: The only
proven strategies to reduce the risks of
tobacco-caused disease are preventing
initiation, facilitating cessation, and
eliminating exposure to secondhand
smoke.
• Describe activities that demonstrate
how the UIHP is implementing this
priority.
(a) September 1, 2013—March 31,
2014 activities planned.
11. Pandemic Preparedness: The
United States is better prepared for an
influenza pandemic. Rapid vaccine
production capacity is increased,
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national stockpiles and distribution
systems are in place, disease monitoring
and communication systems are
expanded and local preparedness
encompasses all levels of government
and society.
• Describe activities that demonstrate
how the UIHP is prepared and identify
changes, if any, made to the UIHP
pandemic preparedness plan.
12. Emergency Response: We have
learned from the past and are better
prepared for the future. There is an ethic
of preparedness at the urban program
and throughout the Nation.
• Describe activities that demonstrate
how the UIHP is prepared and identify
changes, if any, made to the UIHP
emergency preparedness plan.
13. Hours of Operation Ensure Access
to Care:
• Identify the urban program hours of
operation and provide assurance that
services are available and accessible at
times that meets the needs of the urban
Indian population, including
arrangements that assure access to care
when the UIHP is closed.
14. UIHP Collaboration with the
Veteran’s Health Administration (VA)
In 2007, the UIHPs contacted their
local VA Veterans Integrated Services
Network and established agreements to
collaborate at the local level to expand
opportunities to enhance access to
health services and improve the quality
of health care of urban Indian veterans.
(a) Describe plan of action to develop
a partnership with the local VA and
plans to establish a Memorandum of
Understanding for serving urban Indian
veterans.
(b) Identify areas of collaboration and
activities that will be conducted
between your UIHP and your local area
VA for budget period September 1,
2013-March 31, 2014.
15. GPRA Reporting:
All UIHPs report on IHS GPRA/
Government Performance Rating Act
Modernization Act (GPRAMA) clinical
performance measures. This is required
using the Resource and Patient
Management System (RPMS). RPMS
users must use the Clinical Reporting
System (CRS) for reporting. Questions
related to GPRA reporting may be
directed to the IHS Area Office GPRA
Coordinator, or the OUIHP on (301)
443–4680.
The 2014 GPRA Reporting Period is
July 1, 2013 through June 30, 2014. The
GPRA measures to report for 2014
include 25 clinical measures. The 2014
measure targets are attached.
(a) The following GPRA measures are
priority focus areas for target
achievement: Good Glycemic Control,
Childhood Immunizations and
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Depression Screening. Briefly describe
the steps/activities you will take to
ensure your program meets the 2014
target rates for these measures.
(b) Describe at least two actions you
will complete to meet the 2014 desired
performance outcomes/results. For
programs using RPMS, a Performance
Improvement Toolbox is available on
the CRS Web site at https://www.ihs.gov
/cio/crs_performance_improvementtool
box.asp.
(c) GPRA Behavioral Health
performance measures include Alcohol
Screening (to prevent Fetal Alcohol
Syndrome (FAS)), Domestic (Intimate
Partner) Violence Screening and
Depression Screening. Describe actions
you will take to improve 2013–2014
desired behavioral health performance
outcomes/results.
(d) Document your ability to collect
and report on the required performance
measures to meet GPRA requirements.
Include information about your health
information technology system.
tkelley on DSK3SPTVN1PROD with NOTICES
FY 2014 GPRA MEASURES
1. Diabetes DX Ever (not a GPRA
measure, used for context only).
2. Documented A1c (not a GPRA
measure, used for context only).
3. Diabetes: Good Glycemic Control.
4. Diabetes: Controlled Blood
Pressure.
5. Diabetes: Dyslipidemia (LDL)
Assessment.
6. Diabetes: Nephropathy Assessment.
7. Diabetes: Retinopathy Assessment.
8. Influenza Immunization 65+.
9. Pneumovax Immunization 65+.
10. Childhood Immunizations.
11. Pap Screening Rates.
12. Mammography Screening Rates.
13. Colorectal Cancer Screening Rates.
14. Cardiovascular Disease (CVD
Screening Rates).
15. Tobacco Cessation.
16. Alcohol Screening (FAS
Prevention).
17. Domestic Violence/Intimate
Partner Violence Screening.
18. Depression Screening.
19. Prenatal Human
Immunodeficiency Virus (HIV)
Screening.
20. Childhood Weight Control.
21. Breast Feeding Rates.
22. Topical Fluorides.
23. Dental Assessment.
24. Dental Sealants.
25. Suicide Surveillance.
16. Schedule of Charges and
Maximization of Third Party Payments.
(a) Describe the UIHP established
schedule of charges and consistency
with local prevailing rates.
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(1) If the UIHP is not currently billing
for billable services, describe the
process the UIHP will take to begin
third party billing to maximize
collections.
(2) Describe how reimbursement is
maximized from Medicare, Medicaid,
State Children’s Health Insurance
Program, private insurance, etc.
(b) Describe how the UIHP achieves
cost effectiveness in its billing
operations with a brief description of
the following:
(1) Establishes appropriate eligibility
determination.
(2) Reviews/updates and implements
up-to-date billing and collection
practices.
(3) Updates insurance at every visit.
(4) Maintains procedures to evaluate
necessity of services.
(5) Identifies and describes financial
information systems used to track,
analyze and report on the program’s
financial status by revenue generation,
by source, aged accounts receivable,
provider productivity, and encounters
by payor category.
(6) Indicate the date the UIHP last
reviewed and updated its Billing
Policies and Procedures.
(b) Is a descendant, in the first or
second degree, of any such member
described in (A); or
(c) Is an Eskimo or Aleut or other
Alaska Native; or
(d) Is a California Indian; 1
(e) Is considered by the Secretary of
the Department of the Interior to be an
Indian for any purpose; or
(f) Is determined to be an Indian
under regulations pertaining to the
Urban Indian Health Program that are
promulgated by the Secretary, HHS.
1 Eligibility of California Indians may
be demonstrated by documentation that
the individual:
(1) Is a descendent of an Indian who
was residing in California on June 1,
1852; or
(2) Holds trust interests in public
domain, national forest, or Indian
reservation allotments in California; or
(2) Is listed on the plans for
distribution of assets of California
Rancherias and reservations under the
Act of August 18, 1958 (72 Stat. 619), or
is the descendant of such an individual.
The grantee is responsible for taking
reasonable steps to confirm that the
individual is eligible for IHS services as
an urban Indian.
B. PROGRAM PLANNING: WORK
PLANS (40 Points)
PROGRAM NARRATIVES AND
WORKPLANS
A program narrative and a program
specific work plan are required for each
health services program: (1) Health
Promotion/Disease Prevention, (2)
Immunizations, (3) Alcohol/Substance
Abuse, and (4) Mental Health. The
IHCIA, Public Law 111–148, as
amended, identified eligibility for
health services as follows.
The grantee shall provide health care
services to eligible urban Indians living
within the urban center. An ‘‘Urban
Indian’’ eligible for services, as codified
at 25 U.S.C. 1603(13), (27), (28),
includes any individual who:
1. Resides in an urban center, which
is any community that has a sufficient
urban Indian population with unmet
health needs to warrant assistance
under subchapter IV of the IHCIA, as
determined by the Secretary, HHS; and
who
2. Meets one or more of the following
criteria:
(a) Irrespective of whether he or she
lives on or near a reservation, is a
member of a Tribe, band, or other
organized group of Indians, including:
(i) Those Tribes, bands, or groups
terminated since 1940, and (ii) those
recognized now or in the future by the
State in which they reside; or
1. HP/DP
Program Narrative and Work Plan
Contact your IHS Area Office HP/DP
Coordinator to discuss and identify
effective and innovative strategies to
promote health and enhance prevention
efforts to address chronic diseases and
conditions. Identify one or more of the
strategies you will conduct during
budget period September 1, 2013—
March 31, 2014.
(a) Applicants are encouraged to use
evidence-based and promising strategies
which can be found at the IHS best
practice database at https://www.ihs.gov/
hpdp/and the National Registry for
Effective Programs at https://
modelprograms.samhsa.gov/.
(b) Program Narrative. Provide a brief
description of the collaboration
activities that: (1) Will be planned and
will be conducted between the UIHP
and the IHS Area Office HP/DP
Coordinator during the budget period
September 1, 2013 through March 31,
2014.
(c) An example of an HP/DP work
plan is provided on the following pages.
Develop and attach a copy of the UIHP
HP/DP Work Plan for September 1, 2013
through March 31, 2014.
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SAMPLE 2013 HP/DP WORK PLAN
[Goal: To address physical inactivity and consumption of unhealthy food among youth who are in the 4th to 6th grade in the Watson, Kennedy,
Blackwood, and Rocky Hill Elementary schools.]
Objectives
Activities/time line
1. Develop school policies to address physical inactivity
and consumption of unhealthy foods in the first year
of the funding year.
1. Schedule a meeting with
the school health board
in the first quarter of the
project.
2. Establish a parent advisory committee to assist
with the development of
the policy in 2nd quarter.
1. Design pre/post test survey and pilot test with
group of students by 2nd
quarter.
2. Schedule a meeting with
the School Principal to
discuss dates of program implementation by
3rd quarter.
3. Implement the ‘‘Healthy
Eating’’ curriculum, a 6
week program in the 2nd
quarter.
4. Collect pre/post survey
at beginning and end of
the program to assess
changes.
1. Contract with SPARK
PE to train classroom
teachers to implement
SPARK PE in the school
by 3rd Quarter.
2. Train volunteers to administer FITNESSGRAM
to collect baseline data
and post data to assess
changes.
2. Implement a classroom nutrition curriculum to increase awareness about the importance of healthier
foods.
3. Implement physical activity in at least four schools for
grades 4th to 6th in first year of the funding.
Person responsible
Evaluation
Program Coordinator
School Administrator.
Progress report on status
of policy and documentation of number of
participants in parent advisory committee, and
number of meetings
held.
Program Coordinator IHS
Nutritionist.
Pre/post knowledge, attitude, and behavior survey.
Program Coordinator
School Counselor and
PE teacher.
1. Training evaluation and
number of participants.
2. Pre/post
FITNESSGRAM Data.
SAMPLE 2013 HP/DP WORK PLAN
[Goal: To reduce tobacco use among residents of community X and Y.]
Objectives
Activities/time line
Person responsible
Evaluation
1. Establish a tobacco-free policy in the schools and
Tribal buildings by year one.
1. Schedule a meeting with
the Tribal Council and
school board to increase
awareness of the health
effects of tobacco by
June 2010.
2. Schedule and conduct
tobacco awareness education in the community,
schools, and worksites
by July 2010 through
September 2010.
3. Draft a policy and
present to the Tribal
Council for approval by
January 2011.
1. Partner with the American Cancer Association
and the Tribal Health
Education Coordinators
to establish 8-week tobacco cessation programs by July 2010.
Tobacco Coordinator .........
Documentation of the number of participants.
Tobacco Coordinator
Health Educator.
Documentation of the number of participants.
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2. Coordinate and establish tobacco cessation programs with the local hospitals and clinics.
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Documentation of whether
the policy was established.
Tobacco Coordinator
Health Educator Pharmacist.
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Progress toward timeline.
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SAMPLE 2013 HP/DP WORK PLAN—Continued
[Goal: To reduce tobacco use among residents of community X and Y.]
Objectives
Activities/time line
Person responsible
2. Meet with the hospital/
clinic administrators and
pharmacist to discuss
and develop a behaviorbased tobacco cessation
program.
3. Design and disseminate
brochures and flyers of
tobacco cessation program that are available
in the community and
clinic.
4. Meet with nursing and
medical provider staff to
increase patient referral
to tobacco cessation
program.
5. Implement the 8-week
tobacco cessation program at the community
X and Y clinic.
2. IMMUNIZATION SERVICES
Program Narrative and Work Plan
(a) Program Management Required
Activities
(1) Provide assurance that your
facility is participating in the Vaccines
for Children program.
(2) Provide assurance that your
facility has look up capability with
State/regional immunization registry
(where applicable). Please contact Amy
Groom, Immunization Program Manager
at amy.groom@ihsgov or (505) 248–4374
for more information.
(b) Service Delivery Required
Activities—For Sites using RPMS
(1) Provide trainings to providers and
data entry clerks on the RPMS
Immunization package.
(2) Establish process for
immunization data entry into RPMS
Evaluation
Tobacco Coordinator
Health Educator.
Progress report indicating
timeline is being met.
Tobacco Coordinator .........
# of brochures distributed.
Health Educator, Tobacco
Coordinator.
RPMS data—baseline # of
referrals, # of participants who completed
program, # who quit tobacco.
Tobacco Coordinator.
(e.g., point of service or through regular
data entry).
(3) Utilize RPMS Immunization
package to identify 3–27 month old
children who are not up to date and
generate reminder/recall letters.
(c) Immunization Coverage Assessment
Required Activities
(1) Submit quarterly immunization
reports to Area Immunization
Coordinator for the 3–27 month old,
Two year old and Adolescent, Influenza
and Adult reports. Sites not using the
RPMS Immunization package should
submit a Two Year old immunization
coverage report—an excel spreadsheet
with the required data elements that can
be found under the ‘‘Report Forms for
non-RPMS sites’’ section at: https://
www.ihs.gov/Epi/
index.cfm?module=epi_vaccine_reports.
(d) Program Evaluation Required
Activities
(1) Report coverage with the
4313314 ** vaccine series for children
19–35 months old.
(2) Report coverage with influenza
vaccine for adults 65 years and older.
(3) Report coverage with at least one
dose of pneumococcal vaccine for adults
65 years and older.
(4) Report coverage for patients (6
months and older) who received at least
one dose of seasonal flu vaccine during
flu season.
(5) Establish baseline coverage on
adult vaccines, specifically: 1 dose of
Tdap for adults 19 yrs and older; 1 dose
of Human Papillomavirus (HPV) for
females 19–26 years old; 3 doses HPV
for females 19–26 yrs; 1 dose of HPV for
males 19–21 years old; 3 doses HPV for
males 19–21 years; and 1 dose of Zoster
for patients 60+ years.
SAMPLE URBAN GRANT FY 2013 WORK PLAN IMMUNIZATION
Primary prevention objective
Service or program
tkelley on DSK3SPTVN1PROD with NOTICES
Protect children and communities Immunization Profrom vaccine preventable diseases.
gram.
Target population
Process measure
Children < 3 years
On a quarterly basis:
# of children 3–27 months old ..........
# of children 3–27 months old who
are children up to date with age
appropriate vaccinations.
Outcome measures
As of June 30th, 2012:
% of 19–35 month olds
up to date with the
431331 and 4313314
vaccine series.
% of 3–27 month old children up to
date with age appropriate vaccinations.
# of children 19–35 months old.
* The 4:3:1:3:3:1:4 vaccine series is defined as: 4
doses diphtheria and tetanus toxoids and pertussis
vaccine, diphtheria and tetanus toxoids, or
diphtheria and tetanus toxoids and any pertussis
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vaccine, 3 doses of oral or inactivated polio vaccine,
1 dose of measles, mumps, and rubella vaccine, 3
doses of Haemophilus influenzae type b vaccine, 3
doses of hepatitis B vaccine, 1 dose of varicella
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vaccine, and 4 doses of pneumococcal conjugate
vaccine(PCV).
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SAMPLE URBAN GRANT FY 2013 WORK PLAN IMMUNIZATION—Continued
Service or program
Primary prevention objective
Target population
Process measure
Outcome measures
# of children 19–35
months old who received the 431331 and
4313314 vaccine series
Protect adolescents and communities from vaccine preventable
diseases.
Immunization Program.
Adolescents 13–
17 years.
% of children 19–35 months old who
received the 431331 and 4313314
vaccine series.
On a quarterly basis:
# of adolescents 13–17 years old ....
# of adolescents 13–17 years old
who are up to date with Tdap,
Tdap/Td, Meningococcal, and 1, 2
and 3 dose of HPV (females only).
% of adolescents 13–17 years old
who are up to date with Tdap,
Tdap/Td, Meningococcal, and 1, 2
and 3 dose of HPV (females only).
Protect adults and communities from
influenza.
Immunization Program.
All Ages ...............
On a quarterly basis during flu season (e.g., Sept–June).
# of patients (all ages) ......................
# of patients who received a seasonal flu shot during the flu season.
% of patients who received a seasonal flu shot during flu season.
Protect adults and communities from
influenza & Pneumovax.
Immunization Program.
Adults > 65 years
On a quarterly basis:
# of adults 65+ years ........................
# of adults 65+ years who received
an influenza shot during flu season.
# of adults 65+ years who
a pneumovax shot.
% of adults 65+ years who
an influenza shot during
son.
% of adults 65+ years who
a pneumovax shot.
3. ALCOHOL/SUBSTANCE ABUSE
tkelley on DSK3SPTVN1PROD with NOTICES
Program Narrative and Work Plan
(a) Narrative Description of Program
Services for September 1, 2013–March
31, 2014 Budget Period
(1) Program Objectives
(a) Clearly state the outcomes of the
health service.
(b) Define needs related outcomes of
the program health care service.
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(c) Define who is going to do what,
when, how much, and how you will
measure it.
(d) Define the population to be served
and provide specific numbers regarding
the number of eligible clients for whom
services will be provided.
(e) State the time by which the
objectives will be met.
(f) Describe objectives in numerical
terms—specify the number of clients
that will receive services.
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received
received
flu sea-
As of June 30th, 2012:
% of adolescents 13–17
years old who are up
to date with Tdap.
% of adolescents 13–17
years old who are up
to date with Tdap, females only.
# of adolescents 13–17
years old who are up
to date with
Meningococcal vaccine.
# of adolescents 13–17
years old who are up
to date with 1, 2 and 3
dose of HPV (females
only).
As of June 30th, 2012:
# of patients who received a seasonal flu
shot during the flu
season.
% of patients who received a seasonal flu
shot during flu season.
As of June 30th, 2012:
% of adults 65+ years
who received an influenza shot Sept. 1,
2010–June 30, 2011.
% of adults 65+ years
who received a
pneumovax shot ever
received
(g) Describe how achievement of the
goals will produce meaningful and
relevant results (e.g., increase access,
availability, prevention, outreach, preservices, treatment, and/or
intervention).
(h) Provide a one-year work plan that
will include the primary objectives,
services or program, target population,
process measures, outcome measures,
and data source for measures (see work
plan sample in Appendix 2).
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(i) Identify Services Provided: Primary
Residential; Detox; Halfway House;
Counseling; Outreach and Referral; and
Other (Specify)
(ii) Number of beds: Residential __,
Detox__; or Half way House __.
(iii) Average monthly utilization for
the past year.
(iv) Identify Program Type: Integrated
Behavioral Health; Alcohol and
Substance Abuse only; Stand Alone; or
part of a health center or medical
establishment.
(i) Address methamphetamine-related
contacts:
(i) Estimate the number patient
contacts during the budget period,
September 1, 2013—March 31, 2014.
(ii) Describe your formal
methamphetamine prevention and
education program efforts to reduce the
prevalence of methamphetamine abuse
related problems through increased
outreach, education, prevention and
treatment of methamphetamine-related
issues.
(iii) Describe collaborative
programming with other agencies to
coordinate medical, social, educational,
and legal efforts.
(2) Program Activities
(a) Clearly describe the program
activities or steps that will be taken to
achieve the desired outcomes/results.
Describe who will provide (program,
staff) what services (modality, type,
intensity, duration), to whom
(individual characteristics), and in what
context (system, community).
(b) State reasons for selection of
activities.
(c) Describe sequence of activities.
(d) Describe program staffing in
relation to number of clients to be
served.
(e) Identify number of Full Time
Equivalents (FTEs) proposed and
adequacy of this number:
48449
(i) Percentage of FTEs funded by IHS
grant funding; and
(ii) Describe clients and client
selection.
(f) Address the comprehensive nature
of services offered in this program
service area.
(g) Describe and support any unusual
features of the program services, or
extraordinary social and community
involvement.
(h) Present a reasonable scope of
activities that can be accomplished
within the time allotted for program and
program resources.
(3) Accreditation and Practice Model
(a) Name of Program Accreditation.
(b) Type of evidence-based practice.
(c) Type of practice-based model.
(4) Attach the Alcohol/Substance
Abuse Work Plan.
IHS URBAN GRANT FY 2013 WORK PLAN
[Alcohol/Substance Abuse Program Sample Work Plan]
Service or program
Target population
Process measure
Outcome measures
Data source for
measures
What are you
trying to accomplish?
What type of program do you
propose?
Who do you
hope to serve in
your program?
What information will you collect
about the program activities?
What
information will
you collect to
find out the
results of your
program?
Where will you
find the
information you
collect?
To prevent substance abuse
among urban
American Indian youth.
Community-based
substance
abuse prevention curriculum.
American Indian
youth ages 5–
18 years old.
# of youth completing the curriculum, # of sessions conducted, # of staff trained.
Incidence/prevalence of substance abuse/
dependence.
To prevent substance abuse
and related
problems.
tkelley on DSK3SPTVN1PROD with NOTICES
Objectives
After school, summer, and
weekend activities (e.g. outdoor experiential activities,
camps,
classroom
based
problem solving activities).
American Indian
youth ages 5–
14 years old.
# of youth completing community-based sessions, # of parents completing communitybased sessions, # of community-based sessions.
Incidence of
substance
abuse, incidence of negative and
positive attitudes and behaviors, incidence of peer
drug use.
Medical records,
RPMS behavioral health
package, National Youth
Survey.
Charts, RPMS
behavioral
health package, National
Youth Survey.
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IHS URBAN GRANT FY 2013 WORK PLAN—Continued
[Alcohol/Substance Abuse Program Sample Work Plan]
Objectives
Service or program
Target population
Process measure
Outcome measures
Data source for
measures
Reduce drug use
and increase
treatment retention.
Matrix model for outpatient treatment.
American Indian
adult methamphetamine
clients.
# of clients completing program,
# of relapse prevention sessions, # of family and group
therapies, # of drug education
sessions, # of self-help
groups, # of urine tests.
Incidence of
drug use, increase or decrease in
treatment retention, positive or negative urine
samples.
Medical records,
RPMS behavioral health
package, Addiction Severity Index, results of urine
tests.
4. MENTAL HEALTH SERVICES
Program Narrative and Work Plan
Use the alcohol/substance abuse
program narrative description template
to develop the Mental Health Services
program narrative. Attach the UIHP
Mental Health Services Work Plan.
IHS URBAN GRANT FY 2013 WORK PLAN
[Mental Health Program Sample Work Plan]
Service or program
Target population
Process measure
Outcome measures
Data source for
measures
What are you
trying to accomplish?
What type of program do you
propose?
Who do you
hope to serve in
your program?
What information will you collect
about the program activities?
What
information will
you collect to
find out the
results of your
program?
Where will you
find the
information you
collect?
To promote mental health.
American Indian Life Skills Development curriculum.
American Indian
youth ages
13–17 years
old.
# of youth completing the curriculum, # of sessions conducted, # of teachers trained,
number of community resource leaders trained.
Feelings of
hopelessness,
problem solving skills.
Improve the mental health of
American Indian children
and their families.
tkelley on DSK3SPTVN1PROD with NOTICES
Objectives
Home-based, community-based,
and
office-based
mental
health counseling.
American Indian
children and
their families
needing services from our
communitybased program.
# of individual, couples, group,
and family counseling sessions, # of home, community,
and office-based visits.
Reduced child
involvement
in juvenile
justice and
child welfare,
improved coping skills, improved school
attendance
and grades.
Medical records,
RPMS behavioral health
package,
Beck Hopelessness
Scale, problem solving
skills.
Medical records,
RPMS behavioral health
package coping skill
measure, report cards, attendance
records.
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IHS URBAN GRANT FY 2013 WORK PLAN—Continued
[Mental Health Program Sample Work Plan]
Objectives
Service or program
Target population
Process measure
Outcome measures
Data source for
measures
Reduce symptoms related to
trauma.
Mental health counseling with
cognitive behavioral therapy
intervention
and
historical
trauma intervention.
American Indian
adults.
# of individual, couples, group,
and family counseling sessions, # of historical trauma
groups, # of adults counseled.
Incidence of
Post-Traumatic Stress
Disorder
(PTSD) symptoms, incidence of depression, increased coping skills, increased peer
and family
support.
Self-report
PTSD, Beck
Depression
Inventory,
coping skills
measure,
peer and family support
measure,
medical
records,
RPMS behavioral health
package.
RPMS Suicide Reporting Form
Instructions for Completing
tkelley on DSK3SPTVN1PROD with NOTICES
This form is intended as a data
collection tool only. It does not replace
documentation of clinical care in the
medical record and it is not a referral
form. HRN, Date of Act and Provider
Name are required fields. If the
information requested is not known or
not listed as an option, choose
‘‘Unknown’’ or ‘‘Other’’ (with
specification) as appropriate. The form
can be partially completed, saved and
completed at a later time if needed.
LOCAL CASE NUMBER:
Indicate internal tracking number if
used, not required.
DATE FORM COMPLETED:
Indicate the date the Suicide
Reporting Form was completed.
PROVIDER NAME:
Record the name of Provider
completing the form.
DATE OF ACT:
Record Date of Act as mm/dd/yy. If
exact day is unknown, use the month,
1st day of the month (or another default
day), year. If exact date of act is
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unknown, all providers should use the
same default day of the month.
HEALTH RECORD NUMBER:
Record the patient’s health record
number.
DOB/AGE:
Record Date of Birth as mm/dd/yy
and patient’s age.
SEX:
Indicate Male or Female.
COMMUNITY WHERE ACT
OCCURRED:
Record the community code or the
name, county and state of the
community where the act occurred.
EMPLOYMENT STATUS:
Indicate patient’s employment status,
choose one.
RELATIONSHIP STATUS:
Indicate patient’s relationship status,
choose one.
EDUCATION:
Select the highest level of education
attained and if less than a High School
graduate, record the highest grade
completed. Choose one.
SUICIDAL BEHAVIOR:
Identify the self-destructive act,
choose one. Generally, the threshold for
reporting should be ideation with intent
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and plan, or other acts with higher
severity, either attempted or completed.
LOCATION OF ACT:
Indicate location of act, choose one.
PREVIOUS ATTEMPTS:
Indicate number of previous suicide
attempts, choose one.
METHOD:
Indicate method used. Multiple
entries are allowed, check all that apply.
Describe methods not listed.
SUBSTANCE USE INVOLVED:
If known, indicate which substances
the patient was under the influence of
at the time of the act. Multiple entries
allowed, check all that apply. List drugs
not shown.
CONTRIBUTING FACTORS:
Multiple entries allowed, check all
that apply. List contributing factors not
shown.
DISPOSITION:
Indicate the type of follow-up
planned, if known.
NARRATIVE:
Record any other relevant clinical
information not included above.
Last Updated 10/25/12
BILLING CODE 3510–22–P
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C. PROJECT EVALUATION (15
Points)
1. Describe your evaluation plan.
Provide a plan to determine the degree
to which objectives are met and
methods are followed.
2. Describe how you will link program
performance/services to budget
expenditures. Include a discussion of
Uniform Data System (UDS) and GPRA
Report Measures here.
3. Include the following program
specific information:
(a) Describe the expected feasibility
and reasonable outcomes (e.g.,
decreased drug use in those patients
receiving services) and the means by
which you determined these targets or
results.
(b) Identify dates of reviews by the
internal staff to assess efficacy:
(1) Assessment of staff adequacy.
(2) Assessment of current position
descriptions.
(3) Assessment of impact on local
community.
(4) Involvement of local community.
(5) Adequacy of community/
governance board.
(6) Ability to leverage IHS funding to
obtain additional funding.
(7) Additional IHS grants obtained.
(8) New initiatives planned for
funding year.
(9) Customer satisfaction evaluations.
4. Quality Improvement Committee
(QIC).
The UIHP QIC, a planned,
organization-wide, interdisciplinary
team, systematically improves program
performance as a result of its findings
regarding clinical, administrative and
cost-of-care performance issues, and
actual patient care outcomes including
the FY 2012 GPRA report and 2011 UDS
report (results of care including safety of
patients).
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(a) Identify the QIC membership,
roles, functions, and frequency of
meetings. Frequency of meetings shall
be at least quarterly.
(b) Describe how the results of the
QIC reviews provide regular feedback to
the program and community/
governance board to improve services.
(1) September 1, 2013–March 31, 2014
activities planned.
(c) Describe how your facility is
integrating the improving patient care
model into your health delivery
structure:
(1) Identify specific measures you are
tracking as part of the Improvements in
Patient Care (IPC) work.
(2) Identify community members that
are part of your IPC team.
(3) Describe progress meeting your
program’s goals for the use of the IPC
model within your healthcare delivery
model.
D. PROGRESS REPORT:
ORGANIZATIONAL CAPABILITIES
AND QUALIFICATIONS (10 Points)
This section outlines the broader
capacity of the organization to complete
the project outlined in the application
and program specific work plans. This
section includes the identification of
personnel responsible for completing
tasks and the chain of responsibility for
successful completion of the project
outlined in the work plans.
1. Describe the organizational
structure with a current approved one
page organizational chart that shows the
board of directors, key personnel, and
staffing. Key personnel positions
include the Chief Executive Officer or
Executive Director, Chief Financial
Officer, Medical Director, and
Information Officer.
2. Describe the board of directors that
is fully and legally responsible for
operation and performance of the
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501(c)(3) non-profit urban Indian
organization:
(a) List all current board members by
name, sex, and Tribe or race/ethnicity.
(b) Indicate their board office held.
(c) Indicate their occupation or area of
expertise.
(d) Indicate if the board member uses
the UIHP services.
(e) Indicate if the board member lives
in the health service area.
(f) Indicate the number of years of
continuous service.
(g) Indicate number of hours of Board
of Directors training provided, training
dates and attach a copy of the Board of
Directors training curriculum.
3. List key personnel who will work
on the project.
(a) Identify existing key personnel and
new program staff to be hired.
(b) For all new key personnel only
include position descriptions and
resumes in the appendix. Position
descriptions should clearly describe
each position and duties indicating
desired qualifications, experience, and
requirements related to the proposed
project and how they will be
supervised. Resumes must indicate that
the proposed staff member is qualified
to carry out the proposed project
activities and who will determine if the
work of a contractor is acceptable.
(c) Identify who will be writing the
progress reports.
(d) Indicate the percentage of time to
be allocated to this project and identify
the resources used to fund the
remainder of the individual’s salary if
personnel are to be only partially
funded by this grant.
E. CATEGORICAL BUDGET AND
BUDGET JUSTIFICATION (5 Points)
This section should provide a clear
estimate of the project program costs
and justification for expenses for the
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budget period September 1, 2013–March
31, 2014. The budget and budget
justification should be consistent with
the tasks identified in the work plan.
1. Categorical Budget (Form SF 424A,
Budget Information Non-Construction
Programs).
(a) Provide a narrative justification for
all costs, explaining why each line item
is necessary or relevant to the proposed
project. Include sufficient details to
facilitate the determination of cost
allowability.
(b) If indirect costs are claimed,
indicate and apply the current
negotiated rate to the budget. Include a
copy of the current rate agreement in the
appendix.
V. Award Administration Information
Reporting Requirements
Failure to submit required reports
within the time allowed may result in
suspension or termination of an active
agreement, 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 one or
both of the following: (1) The
imposition of special award provisions;
and (2) the non-funding or non-award of
other eligible projects or activities. This
requirement applies whether the
delinquency is attributable to the failure
of the organization or the individual
responsible for preparation of the
reports.
The reporting requirements for this
program are noted below:
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A. Program Progress Report
Program progress reports are required
quarterly. These reports will include a
brief comparison of actual program
accomplishments to the goals
established for the period, reasons for
slippage (if applicable), and other
pertinent information as required. A
final program report must be submitted
within 90 days of expiration of the
budget/project period.
B. Financial Report
Federal Financial Report, (FFR–SF–
425), Cash Transaction Reports are due
every calendar quarter to the Division of
Payment Management, Payment
Management Branch, HHS at: https://
www.dpm.psc.gov. Failure to submit
timely reports may cause a disruption in
timely payments to your organization.
Grantees are responsible and
accountable for accurate information
being reported on all required reports;
the Progress Reports, and Federal
Financial Report.
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C. Federal Subaward Reporting System
(FSRS)
This award may be subject to the
Transparency Act subaward and
executive compensation reporting
requirements of 2 CFR part 170.
The Transparency Act requires the
Office of Management and Budget
(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 firsttier subawards and executive
compensation under Federal assistance
awards.
IHS has implemented a Term of
Award into all IHS Standard Terms and
Conditions, NoAs and funding
announcements regarding the FSRS
reporting requirement. This IHS Term of
Award is applicable to all IHS grant and
cooperative agreements issued on or
after October 1, 2010, with a $25,000
subaward obligation dollar threshold
met for any specific reporting period.
Additionally, all new (discretionary)
IHS awards (where the project period is
made up of more than one budget
period) and where: (1) The project
period start date was October 1, 2010 or
after and (2) the primary awardee will
have a $25,000 subaward obligation
dollar threshold during any specific
reporting period will be required to
address the FSRS reporting. For the full
IHS award term implementing this
requirement and additional award
applicability information, visit the
Grants Management Grants Policy Web
site at: https://www.ihs.gov/dgm/
index.cfm?module=dsp_dgm_policy_
topics.
D. Annual Audit Report
In accordance with 25 U.S.C. 1657,
the reports and records of the urban
Indian organization with respect to a
contract or grant under subchapter IV,
shall be subject to audit by the
Secretary, Department of Health and
Human Services and the Comptroller
General of the United States.
The Secretary shall allow as a cost to
any contract or grant entered into under
section 1653 of this title the cost of an
annual private audit conducted by a
certified public accountant.
E. GPRA Report
GPRA reports are required quarterly.
These reports are submitted to the IHS
Area GPRA Coordinator. RPMS users
must use CRS for reporting. Non-RPMS
users must use the interface system to
transfer data from their current data
system to RPMS for CRS reporting.
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F. Quarterly Immunization Report
Immunization reports are required
quarterly. These reports are submitted to
the IHS Area Immunization
Coordinator.
G. Unmet Needs Report
An unmet needs report is required
quarterly. These reports will include
information gathered to: (1) Identify
gaps between unmet health needs of
urban Indians and the resources
available to meet such needs; and (2)
make recommendations to the Secretary
and Federal, State, local, and other
resource agencies on methods of
improving health service programs to
meet the needs of urban Indians.
VI. Agency Contacts
1. Questions on the programmatic
issues may be directed to: Phyllis Wolfe,
Director, Office of Urban Indian Health
Programs, 801 Thompson Avenue, Suite
200, Rockville, MD 20852, 301–443–
1631, Phyllis.wolfe@ihs.gov.
2. Questions on grants management
and fiscal matters may be directed to:
Pallop Chareonvootitam, Grants
Management Specialist, 801 Thompson
Avenue, Suite 100, Rockville, MD
20852, 301–443–2195,
Pallop.chareonvootitam@ihs.gov.
3. Questions on systems matters may
be directed to: Paul Gettys, Grant
Systems Coordinator, 801 Thompson
Avenue, TMP Suite 360, Rockville, MD
20852, Phone: 301–443–2114; or the
DGM main line 301–443–5204, Fax:
301–443–9602, Email:
Paul.Gettys@ihs.gov.
VII. Other Information
The Public Health Service strongly
encourages all grant and contract
recipients to provide a smoke-free
workplace and promote 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.
Date: July 31, 2013.
Yvette Roubideaux,
Acting Director, Indian Health Service.
[FR Doc. 2013–19113 Filed 8–7–13; 8:45 am]
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[Federal Register Volume 78, Number 153 (Thursday, August 8, 2013)]
[Notices]
[Pages 48441-48454]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-19113]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Office of Urban Indian Health Programs Proposed Single Source
Grant With Native American Lifelines, Inc.
Funding Announcement Number: HHS-2013-IHS-UIHP-0002.
Catalogue of Federal Domestic Assistance Number: 93.193.
Key Dates
Application Deadline Date: August 26, 2013.
Review Period: August 28, 2013.
Earliest Anticipated Start Date: September 1, 2013.
I. Funding Opportunity Description
Statutory Authority
The Indian Health Service (IHS), Office of Urban Indian Health
Programs (OUIHP), announces the FY 2013 single source competing grant
for operation support for the 4-in-1 Title V grant to make health care
services more accessible for American Indians and Alaska Natives (AI/
AN) residing in the Boston metropolitan area. This program is
authorized under the authority of the Snyder Act, 25 U.S.C. 13, and the
Indian Health Care Improvement Act (IHCIA), as amended, 25 U.S.C. 1652,
1653, 1660a. This program is described at 93.193 in the Catalog of
Federal Domestic Assistance (CFDA).
Purpose
Under this grant opportunity, the IHS proposes to award a single
source grant to Native American Lifelines, Inc., which is an urban
Indian organization that has an existing IHS contract, in accordance
with 25 U.S.C. 1653(c)-(f), 1660a, in the Boston metropolitan area.
This grant announcement seeks to ensure the highest possible health
status for urban Indians. Funding will be used to establish the urban
Indian organization's successful implementation of the priorities of
the Department of Health and Human Services (HHS), Strategic Plan
Fiscal Years 2010-2015, Healthy People 2020, and the IHS Strategic Plan
2006-2011. Additionally, funding will be utilized to meet objectives
for Government Performance Rating Act (GPRA) reporting, collaborative
activities with the Veterans Health Administration (VA), and four
health programs that make health services more accessible to urban
Indians. The four health services programs are: (1) Health Promotion/
Disease Prevention (HP/DP) services, (2) Immunizations, (3) Behavioral
Health Services consisting of Alcohol/Substance Abuse services, and (4)
Mental Health Prevention and Treatment services. These programs are
integral components of the IHS improvement in patient care initiative
and the strategic objectives focused on improving safety, quality,
affordability, and accessibility of health care.
Single Source Justification
Native American Lifelines, Inc. is identified as the single source
for this award, based on the following criteria:
1. As required by law, the grants authorized by 25 U.S.C. 1653(c)-
(f), 1660a may only be awarded to those urban Indian organizations that
have a current contract with the IHS to provide health care to urban
Indians, in the urban center identified in the contract.
2. Native American Lifelines is the urban Indian organization IHS
currently contracts with to provide health care and referral services
to urban Indians residing in the Boston area.
Native American Lifelines, Inc. is uniquely qualified to receive
this award and provide the identified program activities based on their
history with the urban Indian health programs, and their knowledge of
urban Indian health and the Boston target population. The program is
licensed by the state as a behavioral health provider; all of the staff
operating at the facility are licensed and credential in their
respective fields (specifically behavioral health); and they use
evidence-based behavioral health assessment and treatment strategies
with success. The program successfully uses targeted outreach and
comprehensive case management services for clients in the community.
Through this outreach and case management, the program has expanded
offering to include on-site dental service and transportation. Also,
the program has been successful in entering into collaborative
agreements with community health resources for the provision of quality
and comprehensive health care for clients. In support of these
successful activities, the Board of Directors is active in the program
and committed to bringing quality health care to the urban Indians of
the Boston metropolitan area.
II. Award Information
Type of Awards
Grant.
Estimated Funds Available
The total amount of funding identified for the current fiscal year
(FY) 2013 is $153,126. Any awards issued under this announcement are
subject to the availability of funds. In the absence of funding, the
Agency is under no obligation to make awards funded under this
announcement.
Anticipated Number of Awards
One single source award will be issued under this program
announcement.
[[Page 48442]]
Project Period
The project periods for this award will be as follows:
Year One: Six Months Budget Period from September 1, 2013 to March
31, 2014.
Year Two: Twelve Months Budget Period from--April 1, 2014 to March
31, 2015.
Year Three: Twelve Months Budget Period from--April 1, 2015 to
March 31, 2016.
IIII. Application and Submission Information
1. Obtaining Application Materials
The application package and detailed instructions for this
announcement can be found at https://www.Grants.gov or https://www.ihs.gov/dgm/index.cfm?module=dsp_dgm_funding. Questions regarding
the electronic application process may be directed to Mr. Paul Gettys
at (301) 443-2114.
2. Content and Form Application Submission
The applicant must include the project narrative as an attachment
to the application package. Mandatory documents for all applicants
include:
Table of contents.
Abstract (one page) summarizing the project.
Application forms:
[cir] SF-424, Application for Federal Assistance.
[cir] SF-424A, Budget Information--Non-Construction Programs.
[cir] SF-424B, Assurances--Non-Construction Programs.
Budget Justification and Narrative (must be single-spaced and
not exceed five pages).
Project Narrative (must be single spaced and not exceed ten
pages).
[cir] Background information on the organization.
[cir] Proposed scope of work, objectives, and activities that
provide a description of what will be accomplished, including a one-
page Timeframe Chart.
501(c)(3) Certificate.
Disclosure of Lobbying Activities (SF-LLL).
Certification Regarding Lobbying (GG-Lobbying Form).
Copy of current Negotiated Indirect Cost rate (IDC) agreement
(required) in order to receive IDC.
Documentation of current OMB A-133 required Financial Audit
(if applicable).
Acceptable forms of documentation include:
[cir] Email confirmation from Federal Audit Clearinghouse (FAC)
that audits were submitted; or
[cir] Face sheets from audit reports. These can be found on the FAC
Web site: https://harvester.census.gov/sac/dissem/accessoptions.html?submit=Go+To+Database.
Public Policy Requirements
All Federal-wide public policies apply to IHS grants with exception
of the Discrimination policy.
Requirements for Project and Budget Narratives
A. Project Narrative: This narrative should be a separate Word
document that is no longer than ten pages and must: be single-spaced,
be typewritten, have consecutively numbered pages, use black type not
smaller than 12 characters per one inch, and be printed on one side
only of standard size 8\1/2\'' x 11'' paper. These narratives will
assist the Objective Review Committee (ORC) in becoming more familiar
with the grantee's activities and accomplishments prior to this
possible grant award. If the narrative exceeds the page limit, only the
first ten pages will be reviewed. The 10-page limit for the narrative
does not include the work plan, standard forms, table of contents,
budget, budget justifications, narratives, and/or other appendix items.
B. Budget Narrative: This narrative must describe the budget
requested and match the scope of work described in the project
narrative. The budget narrative should not exceed five pages.
3. Submission Dates and Times
Applications must be submitted electronically through Grants.gov by
12:00 a.m., midnight Eastern Daylight Time (EDT) on the Application
Deadline Date listed in the Key Dates section on page one of this
announcement. Any application received after the application deadline
will not be accepted for processing, nor will it be given further
consideration for funding. The applicant will be notified by the
Division of Grants Management (DGM) via email of this decision.
If technical challenges arise and assistance is required with the
electronic application process, contact Grants.gov Customer Support via
email to support@grants.gov or at (800) 518-4726. Customer Support is
available to address questions 24 hours a day, 7 days a week (except on
Federal holidays). If problems persist, contact Mr. Paul Gettys, DGM
(Paul.Gettys@ihs.gov) at (301) 443-2114. Please be sure to contact Mr.
Gettys at least ten days prior to the application deadline. Please do
not contact the DGM until you have received a Grants.gov tracking
number. In the event you are not able to obtain a tracking number, call
the DGM as soon as possible.
If the applicant needs to submit a paper application instead of
submitting electronically via Grants.gov, prior approval must be
requested and obtained (see Section IV.6 below for additional
information). The waiver must be documented in writing (emails are
acceptable), before submitting a paper application. A copy of the
written approval must be submitted with the hardcopy that is mailed to
the DGM. Once the waiver request has been approved, the applicant will
receive a confirmation of approval and the mailing address to submit
the application. Paper applications that are submitted without a waiver
from the Acting Director of DGM will not be reviewed or considered
further for funding. The applicant will be notified via email of this
decision by the Grants Management Officer of DGM. Paper applications
must be received by the DGM no later than 5:00 p.m., EST, on the
Application Deadline Date listed in the Key Dates section on page one
of this announcement. Late applications will not be accepted for
processing or considered for funding.
4. Intergovernmental Review
Executive Order 12372 requiring intergovernmental review is not
applicable to this program.
5. Funding Restrictions
Pre-award costs are not allowable.
The available funds are inclusive of direct and
appropriate indirect costs.
IHS will not acknowledge receipt of applications.
6. Electronic Submission Requirements
All applications must be submitted electronically. Please use the
https://www.Grants.gov Web site to submit an application electronically
and select the ``Find Grant Opportunities'' link on the homepage.
Download a copy of the application package, complete it offline, and
then upload and submit the completed application via the https://www.Grants.gov Web site. Electronic copies of the application may not
be submitted as attachments to email messages addressed to IHS
employees or offices.
If the applicant receives a waiver to submit paper application
documents, the applicant must follow the rules and timelines that are
noted below. The applicant must seek assistance at least ten days prior
to the Application Deadline Date listed in the Key Dates
[[Page 48443]]
section on page one of this announcement.
Applicants that do not adhere to the timelines for System for Award
Management (SAM) and/or https://www.Grants.gov registration or that fail
to request timely assistance with technical issues will not be
considered for a waiver to submit a paper application.
Please be aware of the following:
Please search for the application package in https://www.Grants.gov by entering the CFDA number or the Funding Opportunity
Number. Both numbers are located in the header of this announcement.
If technical challenges are experienced while submitting
the application electronically, please contact Grants.gov Support
directly at: support@grants.gov or (800) 518-4726. Customer Support is
available to address questions 24 hours a day, 7 days a week (except on
Federal holidays).
Upon contacting Grants.gov, obtain a tracking number as
proof of contact. The tracking number is helpful if there are technical
issues that cannot be resolved and waiver from the agency must be
obtained.
If it is determined that a waiver is needed, the applicant
must submit a request in writing (emails are acceptable) to
GrantsPolicy@ihs.gov with a copy to Tammy.Bagley@ihs.gov. Please
include a clear justification for the need to deviate from the standard
electronic submission process.
If the waiver is approved, the application should be sent
directly to the DGM by the Application Deadline Date listed in the Key
Dates section on page one of this announcement.
An applicant is strongly encouraged not to wait until the
deadline date to begin the application process through Grants.gov as
the registration process for SAM and Grants.gov could take up to
fifteen working days.
Please use the optional attachment feature in Grants.gov
to attach additional documentation that may be requested by the DGM.
An applicant must comply with any page limitation
requirements described in this Funding Announcement.
After electronically submitting the application, the
applicant will receive an automatic acknowledgment from Grants.gov that
contains a Grants.gov tracking number. The DGM will download the
application from Grants.gov and provide necessary copies to the
appropriate agency officials. Neither the DGM nor the OCPS will notify
the applicant that the application has been received.
Email applications will not be accepted under this
announcement.
Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS)
All IHS applicants and grantee organizations are required to obtain
a DUNS number and maintain an active registration in the SAM database.
The DUNS number is a unique 9-digit identification number provided by
D&B which uniquely identifies each entity. The DUNS number is site
specific; therefore, each distinct performance site may be assigned a
DUNS number. Obtaining a DUNS number is easy, and there is no charge.
To obtain a DUNS number, please access it through https://fedgov.dnb.com/webform, or to expedite the process, call (866) 705-
5711.
All HHS recipients are required by the Federal Funding
Accountability and Transparency Act of 2006, as amended (``Transparency
Act''), to report information on subawards. Accordingly, all IHS
grantees must notify potential first-tier subrecipients that no entity
may receive a first-tier subaward unless the entity has provided its
DUNS number to the prime grantee organization. This requirement ensures
the use of a universal identifier to enhance the quality of information
available to the public pursuant to the ``Transparency Act.''
System for Award Management (SAM)
Organizations that were not registered with Central Contractor
Registration (CCR) and have not registered with SAM will need to obtain
a DUNS number first and then access the SAM online registration through
the SAM home page at https://www.sam.gov (U.S. organizations will also
need to provide an Employer Identification Number from the Internal
Revenue Service that may take an additional 2-5 weeks to become
active). Completing and submitting the registration takes approximately
one hour to complete and SAM registration will take 3-5 business days
to process. Registration with the SAM is free of charge. Applicants may
register online at https://www.sam.gov.
Additional information on implementing the ``Transparency Act,''
including the specific requirements for DUNS and SAM, can be found on
the IHS Grants Management, Grants Policy Web site: https://www.ihs.gov/dgm/index.cfm?module=dsp_dgm_policy_topics.
IV. Application Review Information
The instructions for preparing the application narrative also
constitute the evaluation criteria for reviewing and scoring the
application. Weights assigned to each section are noted in parentheses.
The 10-page narrative should include only the first year of activities;
information for multi-year projects should be included as an appendix.
See ``Multi-year Project Requirements'' at the end of this section for
more information. The narrative section should be written in a manner
that is clear to outside reviewers unfamiliar with prior related
activities of the applicant. It should be well organized, succinct, and
contain all information necessary for reviewers to understand the
project fully. Points will be assigned to each evaluation criteria
adding up to a total of 100 points. A minimum score of 75 points is
required for approval and funding. Points are assigned as follows:
1. Criteria
The instructions for preparing the application narrative also
constitute the evaluation criteria for reviewing the application.
The narrative should address program progress for the seven months
budget period activities, September 1, 2013 through March 31, 2014.
The narrative should be written in a manner that is clear to
outside reviewers unfamiliar with prior related activities of the urban
Indian health programs (UIHP). It should be well organized, succinct,
and contain all information necessary for reviewers to fully understand
the project.
Points assigned for the criteria are as follows:
UNDERSTANDING OF THE NEED AND NECESSARY CAPACITY (30 Points)
WORK PLANS (40 Points)
PROJECT EVALUATION (15 Points)
ORGANIZATIONAL CAPABILITIES AND QUALIFICATIONS (10 Points)
CATEGORICAL BUDGET AND BUDGET JUSTIFICATION (5 Points)
A. PROJECT NARRATIVE: UNDERSTANDING OF THE NEED AND NECESSARY CAPACITY
(30 points)
1. Facility Capability:
The UIHPs provide health care services within the context of the
HHS Strategic Plan, Fiscal Years 2010-2015; the IHS Strategic Plan
2006-2011, and four IHS priorities.
Describe the UIHP: Define activities planned for the 2013 budget
period September 1, 2013--March 31, 2014 budget period in each of the
following areas:
(a) IHS Priorities for American Indian/Alaska Native Health Care
Current governmental trends and environmental
[[Page 48444]]
issues impact urban Indians and require clear and consistent support by
the IHS funded UIHP. The IHS Web site is https://www.ihs.gov.
(1) Renew and Strengthen Partnerships with Tribes and the UIHPs:
The UIHPs have a hybrid relationship with the IHS. With the passage of
Public Law 111-148, the Indian Health Care Improvement Act was made
permanent.
Identify what the UIHP is doing to strengthen its
partnerships with Tribes and other UIHPs.
(a) September 1, 2013--March 31, 2014 activities planned, including
information on how results are shared with the community.
(b) List the top ten Tribes whose members are seen by the program.
2. Bring Health Care Reform to the UIHPs: In order to support
health care reform, it must be demonstrated there is a willingness to
change and improve, i.e., in human resources and business practices.
Describe activities the UIHP is taking to ensure health
care reform is being implemented.
(a) September 1, 2013--March 31, 2014 activities planned.
3. Improve the Quality of and Access to Care: Customer service is
the key to quality care. Treating patients well is the first step to
improving quality and access. This area also incorporates Best
Practices in customer service.
Identify activities that demonstrate the UIHP is improving
quality of and access to care.
(a) September 1, 2013--March 31, 2014 activities planned.
4. Ensure all UIHP work is Transparent, Accountable, Fair, and
Inclusive: Quality health care needs to be transparent, with all
parties held accountable for that care. Accountability for services is
emphasized.
Describe activities that demonstrate how this is
implemented in the UIHP program.
(a) September 1, 2013--March 31, 2014 activities planned.
5. HHS Priorities for Health Care:
Current governmental trends and environmental issues impact urban
Indians and require clear and consistent support by the IHS funded
UIHP.
(a) Health Care Value Incentives: The growth of health care costs
is restrained because consumers know the comparative costs and quality
of their health care--and they have a financial incentive to care.
Identify what the UIHP is doing to help its consumers gain
control of their health care and have the knowledge to make informed
health care decisions.
(1) September 1, 2013--March 31, 2014 activities planned, including
information on how clinical quality data is shared with consumers and
the community.
6. Health Information Technology: Secure interoperable electronic
records are available to patients and their doctors anytime, anywhere.
Describe Resource Patient Management Systems (RPMS)/
Electronic Health Record (EHR) or non-RPMS activities the UIHP is
taking to ensure immediate access to accurate information to reduce
dangerous medical errors and help control health care costs.
(a) September 1, 2013-March 31, 2014 activities planned.
7. Medicare Rx: Every senior has access to affordable prescription
drugs. Consumers will inspire plans to provide better benefits at lower
costs. Medicare Part D is streamlined and improved to better connect
people with their benefits. Pay for Performance methodologies act to
increase health care quality.
Identify activities the UIHP is taking to implement
Medicare Rx.
(a) September 1, 2013--March 31, 2014 activities planned.
8. Personalized Health Care: Health care is tailored to the
individual. Prevention and wellness is emphasized. Propensities for
disease are identified and addressed through preemptive intervention.
Describe activities that demonstrate how this is
implemented in the UIHP program.
(a) September 1, 2013--March 31, 2014 activities planned.
9. Obesity Prevention: The risk of many diseases and health
conditions are reduced through actions that prevent obesity. A culture
of wellness deters or diminishes debilitating and costly health events.
Individual health care is built on a foundation of responsibility for
personal wellness.
Describe activities that demonstrate how the UIHP program
is implementing this priority.
(a) September 1, 2013--December 31, 2014 activities planned.
10. Tobacco Cessation: The only proven strategies to reduce the
risks of tobacco-caused disease are preventing initiation, facilitating
cessation, and eliminating exposure to secondhand smoke.
Describe activities that demonstrate how the UIHP is
implementing this priority.
(a) September 1, 2013--March 31, 2014 activities planned.
11. Pandemic Preparedness: The United States is better prepared for
an influenza pandemic. Rapid vaccine production capacity is increased,
national stockpiles and distribution systems are in place, disease
monitoring and communication systems are expanded and local
preparedness encompasses all levels of government and society.
Describe activities that demonstrate how the UIHP is
prepared and identify changes, if any, made to the UIHP pandemic
preparedness plan.
12. Emergency Response: We have learned from the past and are
better prepared for the future. There is an ethic of preparedness at
the urban program and throughout the Nation.
Describe activities that demonstrate how the UIHP is
prepared and identify changes, if any, made to the UIHP emergency
preparedness plan.
13. Hours of Operation Ensure Access to Care:
Identify the urban program hours of operation and provide
assurance that services are available and accessible at times that
meets the needs of the urban Indian population, including arrangements
that assure access to care when the UIHP is closed.
14. UIHP Collaboration with the Veteran's Health Administration
(VA)
In 2007, the UIHPs contacted their local VA Veterans Integrated
Services Network and established agreements to collaborate at the local
level to expand opportunities to enhance access to health services and
improve the quality of health care of urban Indian veterans.
(a) Describe plan of action to develop a partnership with the local
VA and plans to establish a Memorandum of Understanding for serving
urban Indian veterans.
(b) Identify areas of collaboration and activities that will be
conducted between your UIHP and your local area VA for budget period
September 1, 2013-March 31, 2014.
15. GPRA Reporting:
All UIHPs report on IHS GPRA/Government Performance Rating Act
Modernization Act (GPRAMA) clinical performance measures. This is
required using the Resource and Patient Management System (RPMS). RPMS
users must use the Clinical Reporting System (CRS) for reporting.
Questions related to GPRA reporting may be directed to the IHS Area
Office GPRA Coordinator, or the OUIHP on (301) 443-4680.
The 2014 GPRA Reporting Period is July 1, 2013 through June 30,
2014. The GPRA measures to report for 2014 include 25 clinical
measures. The 2014 measure targets are attached.
(a) The following GPRA measures are priority focus areas for target
achievement: Good Glycemic Control, Childhood Immunizations and
[[Page 48445]]
Depression Screening. Briefly describe the steps/activities you will
take to ensure your program meets the 2014 target rates for these
measures.
(b) Describe at least two actions you will complete to meet the
2014 desired performance outcomes/results. For programs using RPMS, a
Performance Improvement Toolbox is available on the CRS Web site at
https://www.ihs.gov/cio/crs_performance_improvementtoolbox.asp.
(c) GPRA Behavioral Health performance measures include Alcohol
Screening (to prevent Fetal Alcohol Syndrome (FAS)), Domestic (Intimate
Partner) Violence Screening and Depression Screening. Describe actions
you will take to improve 2013-2014 desired behavioral health
performance outcomes/results.
(d) Document your ability to collect and report on the required
performance measures to meet GPRA requirements. Include information
about your health information technology system.
FY 2014 GPRA MEASURES
1. Diabetes DX Ever (not a GPRA measure, used for context only).
2. Documented A1c (not a GPRA measure, used for context only).
3. Diabetes: Good Glycemic Control.
4. Diabetes: Controlled Blood Pressure.
5. Diabetes: Dyslipidemia (LDL) Assessment.
6. Diabetes: Nephropathy Assessment.
7. Diabetes: Retinopathy Assessment.
8. Influenza Immunization 65+.
9. Pneumovax Immunization 65+.
10. Childhood Immunizations.
11. Pap Screening Rates.
12. Mammography Screening Rates.
13. Colorectal Cancer Screening Rates.
14. Cardiovascular Disease (CVD Screening Rates).
15. Tobacco Cessation.
16. Alcohol Screening (FAS Prevention).
17. Domestic Violence/Intimate Partner Violence Screening.
18. Depression Screening.
19. Prenatal Human Immunodeficiency Virus (HIV) Screening.
20. Childhood Weight Control.
21. Breast Feeding Rates.
22. Topical Fluorides.
23. Dental Assessment.
24. Dental Sealants.
25. Suicide Surveillance.
16. Schedule of Charges and Maximization of Third Party Payments.
(a) Describe the UIHP established schedule of charges and
consistency with local prevailing rates.
(1) If the UIHP is not currently billing for billable services,
describe the process the UIHP will take to begin third party billing to
maximize collections.
(2) Describe how reimbursement is maximized from Medicare,
Medicaid, State Children's Health Insurance Program, private insurance,
etc.
(b) Describe how the UIHP achieves cost effectiveness in its
billing operations with a brief description of the following:
(1) Establishes appropriate eligibility determination.
(2) Reviews/updates and implements up-to-date billing and
collection practices.
(3) Updates insurance at every visit.
(4) Maintains procedures to evaluate necessity of services.
(5) Identifies and describes financial information systems used to
track, analyze and report on the program's financial status by revenue
generation, by source, aged accounts receivable, provider productivity,
and encounters by payor category.
(6) Indicate the date the UIHP last reviewed and updated its
Billing Policies and Procedures.
B. PROGRAM PLANNING: WORK PLANS (40 Points)
A program narrative and a program specific work plan are required
for each health services program: (1) Health Promotion/Disease
Prevention, (2) Immunizations, (3) Alcohol/Substance Abuse, and (4)
Mental Health. The IHCIA, Public Law 111-148, as amended, identified
eligibility for health services as follows.
The grantee shall provide health care services to eligible urban
Indians living within the urban center. An ``Urban Indian'' eligible
for services, as codified at 25 U.S.C. 1603(13), (27), (28), includes
any individual who:
1. Resides in an urban center, which is any community that has a
sufficient urban Indian population with unmet health needs to warrant
assistance under subchapter IV of the IHCIA, as determined by the
Secretary, HHS; and who
2. Meets one or more of the following criteria:
(a) Irrespective of whether he or she lives on or near a
reservation, is a member of a Tribe, band, or other organized group of
Indians, including: (i) Those Tribes, bands, or groups terminated since
1940, and (ii) those recognized now or in the future by the State in
which they reside; or
(b) Is a descendant, in the first or second degree, of any such
member described in (A); or
(c) Is an Eskimo or Aleut or other Alaska Native; or
(d) Is a California Indian; \1\
(e) Is considered by the Secretary of the Department of the
Interior to be an Indian for any purpose; or
(f) Is determined to be an Indian under regulations pertaining to
the Urban Indian Health Program that are promulgated by the Secretary,
HHS.
\1\ Eligibility of California Indians may be demonstrated by
documentation that the individual:
(1) Is a descendent of an Indian who was residing in California on
June 1, 1852; or
(2) Holds trust interests in public domain, national forest, or
Indian reservation allotments in California; or
(2) Is listed on the plans for distribution of assets of California
Rancherias and reservations under the Act of August 18, 1958 (72 Stat.
619), or is the descendant of such an individual.
The grantee is responsible for taking reasonable steps to confirm
that the individual is eligible for IHS services as an urban Indian.
PROGRAM NARRATIVES AND WORKPLANS
1. HP/DP
Program Narrative and Work Plan
Contact your IHS Area Office HP/DP Coordinator to discuss and
identify effective and innovative strategies to promote health and
enhance prevention efforts to address chronic diseases and conditions.
Identify one or more of the strategies you will conduct during budget
period September 1, 2013--March 31, 2014.
(a) Applicants are encouraged to use evidence-based and promising
strategies which can be found at the IHS best practice database at
https://www.ihs.gov/hpdp/and the National Registry for Effective
Programs at https://modelprograms.samhsa.gov/.
(b) Program Narrative. Provide a brief description of the
collaboration activities that: (1) Will be planned and will be
conducted between the UIHP and the IHS Area Office HP/DP Coordinator
during the budget period September 1, 2013 through March 31, 2014.
(c) An example of an HP/DP work plan is provided on the following
pages. Develop and attach a copy of the UIHP HP/DP Work Plan for
September 1, 2013 through March 31, 2014.
[[Page 48446]]
Sample 2013 HP/DP Work Plan
[Goal: To address physical inactivity and consumption of unhealthy food among youth who are in the 4th to 6th
grade in the Watson, Kennedy, Blackwood, and Rocky Hill Elementary schools.]
----------------------------------------------------------------------------------------------------------------
Objectives Activities/time line Person responsible Evaluation
----------------------------------------------------------------------------------------------------------------
1. Develop school policies to address 1. Schedule a meeting Program Coordinator Progress report on
physical inactivity and consumption with the school health School Administrator. status of policy and
of unhealthy foods in the first year board in the first documentation of
of the funding year. quarter of the project. number of participants
2. Establish a parent in parent advisory
advisory committee to committee, and number
assist with the of meetings held.
development of the
policy in 2nd quarter.
2. Implement a classroom nutrition 1. Design pre/post test Program Coordinator IHS Pre/post knowledge,
curriculum to increase awareness survey and pilot test Nutritionist. attitude, and behavior
about the importance of healthier with group of students survey.
foods. by 2nd quarter.
2. Schedule a meeting
with the School
Principal to discuss
dates of program
implementation by 3rd
quarter.
3. Implement the
``Healthy Eating''
curriculum, a 6 week
program in the 2nd
quarter.
4. Collect pre/post
survey at beginning
and end of the program
to assess changes.
3. Implement physical activity in at 1. Contract with SPARK Program Coordinator 1. Training evaluation
least four schools for grades 4th to PE to train classroom School Counselor and and number of
6th in first year of the funding. teachers to implement PE teacher. participants.
SPARK PE in the school
by 3rd Quarter.
2. Train volunteers to 2. Pre/post FITNESSGRAM
administer FITNESSGRAM Data.
to collect baseline
data and post data to
assess changes.
----------------------------------------------------------------------------------------------------------------
Sample 2013 HP/DP Work Plan
[Goal: To reduce tobacco use among residents of community X and Y.]
----------------------------------------------------------------------------------------------------------------
Objectives Activities/time line Person responsible Evaluation
----------------------------------------------------------------------------------------------------------------
1. Establish a tobacco-free policy in 1. Schedule a meeting Tobacco Coordinator.... Documentation of the
the schools and Tribal buildings by with the Tribal number of
year one. Council and school participants.
board to increase
awareness of the
health effects of
tobacco by June 2010.
2. Schedule and conduct Tobacco Coordinator Documentation of the
tobacco awareness Health Educator. number of
education in the participants.
community, schools,
and worksites by July
2010 through September
2010.
3. Draft a policy and Documentation of
present to the Tribal whether the policy was
Council for approval established.
by January 2011.
2. Coordinate and establish tobacco 1. Partner with the Tobacco Coordinator Progress toward
cessation programs with the local American Cancer Health Educator timeline.
hospitals and clinics. Association and the Pharmacist.
Tribal Health
Education Coordinators
to establish 8-week
tobacco cessation
programs by July 2010.
[[Page 48447]]
2. Meet with the Tobacco Coordinator Progress report
hospital/clinic Health Educator. indicating timeline is
administrators and being met.
pharmacist to discuss
and develop a behavior-
based tobacco
cessation program.
3. Design and Tobacco Coordinator.... of brochures
disseminate brochures distributed.
and flyers of tobacco
cessation program that
are available in the
community and clinic.
4. Meet with nursing Health Educator, RPMS data--baseline
and medical provider Tobacco Coordinator. of
staff to increase referrals,
patient referral to of participants who
tobacco cessation completed program,
program. who quit
tobacco.
5. Implement the 8-week Tobacco Coordinator....
tobacco cessation
program at the
community X and Y
clinic.
----------------------------------------------------------------------------------------------------------------
2. IMMUNIZATION SERVICES
Program Narrative and Work Plan
(a) Program Management Required Activities
(1) Provide assurance that your facility is participating in the
Vaccines for Children program.
(2) Provide assurance that your facility has look up capability
with State/regional immunization registry (where applicable). Please
contact Amy Groom, Immunization Program Manager at amy.groom@ihsgov or
(505) 248-4374 for more information.
(b) Service Delivery Required Activities--For Sites using RPMS
(1) Provide trainings to providers and data entry clerks on the
RPMS Immunization package.
(2) Establish process for immunization data entry into RPMS (e.g.,
point of service or through regular data entry).
(3) Utilize RPMS Immunization package to identify 3-27 month old
children who are not up to date and generate reminder/recall letters.
(c) Immunization Coverage Assessment Required Activities
(1) Submit quarterly immunization reports to Area Immunization
Coordinator for the 3-27 month old, Two year old and Adolescent,
Influenza and Adult reports. Sites not using the RPMS Immunization
package should submit a Two Year old immunization coverage report--an
excel spreadsheet with the required data elements that can be found
under the ``Report Forms for non-RPMS sites'' section at: https://www.ihs.gov/Epi/index.cfm?module=epi_vaccine_reports.
(d) Program Evaluation Required Activities
(1) Report coverage with the 4313314 \**\ vaccine series for
children 19-35 months old.
---------------------------------------------------------------------------
\*\ The 4:3:1:3:3:1:4 vaccine series is defined as: 4 doses
diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and
tetanus toxoids, or diphtheria and tetanus toxoids and any pertussis
vaccine, 3 doses of oral or inactivated polio vaccine, 1 dose of
measles, mumps, and rubella vaccine, 3 doses of Haemophilus
influenzae type b vaccine, 3 doses of hepatitis B vaccine, 1 dose of
varicella vaccine, and 4 doses of pneumococcal conjugate
vaccine(PCV).
---------------------------------------------------------------------------
(2) Report coverage with influenza vaccine for adults 65 years and
older.
(3) Report coverage with at least one dose of pneumococcal vaccine
for adults 65 years and older.
(4) Report coverage for patients (6 months and older) who received
at least one dose of seasonal flu vaccine during flu season.
(5) Establish baseline coverage on adult vaccines, specifically: 1
dose of Tdap for adults 19 yrs and older; 1 dose of Human
Papillomavirus (HPV) for females 19-26 years old; 3 doses HPV for
females 19-26 yrs; 1 dose of HPV for males 19-21 years old; 3 doses HPV
for males 19-21 years; and 1 dose of Zoster for patients 60+ years.
Sample Urban Grant FY 2013 Work Plan Immunization
--------------------------------------------------------------------------------------------------------------------------------------------------------
Primary prevention objective Service or program Target population Process measure Outcome measures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Protect children and communities Immunization Program.. Children < 3 years.... On a quarterly basis: As of June 30th, 2012:
from vaccine preventable diseases. of children 3-27
months old.
of children 3-27 % of 19-35 month olds up to date with
months old who are the 431331 and 4313314 vaccine
children up to date with series.
age appropriate
vaccinations.
% of 3-27 month old
children up to date with
age appropriate
vaccinations.
of children 19-35
months old.
[[Page 48448]]
of children 19-35 months
old who received the 431331 and
4313314 vaccine series
% of children 19-35 months
old who received the
431331 and 4313314 vaccine
series.
Protect adolescents and communities Immunization Program.. Adolescents 13-17 On a quarterly basis:...... As of June 30th, 2012:
from vaccine preventable diseases. years. of adolescents 13-
17 years old.
of adolescents 13- % of adolescents 13-17 years old who
17 years old who are up to are up to date with Tdap.
date with Tdap, Tdap/Td,
Meningococcal, and 1, 2
and 3 dose of HPV (females
only).
% of adolescents 13-17 % of adolescents 13-17 years old who
years old who are up to are up to date with Tdap, females
date with Tdap, Tdap/Td, only.
Meningococcal, and 1, 2
and 3 dose of HPV (females
only).
of adolescents 13-17 years
old who are up to date with
Meningococcal vaccine.
of adolescents 13-17 years
old who are up to date with 1, 2 and
3 dose of HPV (females only).
Protect adults and communities from Immunization Program.. All Ages.............. On a quarterly basis during As of June 30th, 2012:
influenza. flu season (e.g., Sept-
June).
of patients (all of patients who received a
ages). seasonal flu shot during the flu
season.
of patients who
received a seasonal flu
shot during the flu season.
% of patients who received % of patients who received a seasonal
a seasonal flu shot during flu shot during flu season.
flu season.
Protect adults and communities from Immunization Program.. Adults > 65 years..... On a quarterly basis: As of June 30th, 2012:
influenza & Pneumovax. of adults 65+
years.
of adults 65+ % of adults 65+ years who received an
years who received an influenza shot Sept. 1, 2010-June
influenza shot during flu 30, 2011.
season.
of adults 65+ % of adults 65+ years who received a
years who received a pneumovax shot ever
pneumovax shot.
% of adults 65+ years who
received an influenza shot
during flu season.
% of adults 65+ years who
received a pneumovax shot.
--------------------------------------------------------------------------------------------------------------------------------------------------------
3. ALCOHOL/SUBSTANCE ABUSE
Program Narrative and Work Plan
(a) Narrative Description of Program Services for September 1, 2013-
March 31, 2014 Budget Period
(1) Program Objectives
(a) Clearly state the outcomes of the health service.
(b) Define needs related outcomes of the program health care
service.
(c) Define who is going to do what, when, how much, and how you
will measure it.
(d) Define the population to be served and provide specific numbers
regarding the number of eligible clients for whom services will be
provided.
(e) State the time by which the objectives will be met.
(f) Describe objectives in numerical terms--specify the number of
clients that will receive services.
(g) Describe how achievement of the goals will produce meaningful
and relevant results (e.g., increase access, availability, prevention,
outreach, pre-services, treatment, and/or intervention).
(h) Provide a one-year work plan that will include the primary
objectives, services or program, target population, process measures,
outcome measures, and data source for measures (see work plan sample in
Appendix 2).
[[Page 48449]]
(i) Identify Services Provided: Primary Residential; Detox; Halfway
House; Counseling; Outreach and Referral; and Other (Specify)
(ii) Number of beds: Residential ----, Detox----; or Half way House
----.
(iii) Average monthly utilization for the past year.
(iv) Identify Program Type: Integrated Behavioral Health; Alcohol
and Substance Abuse only; Stand Alone; or part of a health center or
medical establishment.
(i) Address methamphetamine-related contacts:
(i) Estimate the number patient contacts during the budget period,
September 1, 2013--March 31, 2014.
(ii) Describe your formal methamphetamine prevention and education
program efforts to reduce the prevalence of methamphetamine abuse
related problems through increased outreach, education, prevention and
treatment of methamphetamine-related issues.
(iii) Describe collaborative programming with other agencies to
coordinate medical, social, educational, and legal efforts.
(2) Program Activities
(a) Clearly describe the program activities or steps that will be
taken to achieve the desired outcomes/results. Describe who will
provide (program, staff) what services (modality, type, intensity,
duration), to whom (individual characteristics), and in what context
(system, community).
(b) State reasons for selection of activities.
(c) Describe sequence of activities.
(d) Describe program staffing in relation to number of clients to
be served.
(e) Identify number of Full Time Equivalents (FTEs) proposed and
adequacy of this number:
(i) Percentage of FTEs funded by IHS grant funding; and
(ii) Describe clients and client selection.
(f) Address the comprehensive nature of services offered in this
program service area.
(g) Describe and support any unusual features of the program
services, or extraordinary social and community involvement.
(h) Present a reasonable scope of activities that can be
accomplished within the time allotted for program and program
resources.
(3) Accreditation and Practice Model
(a) Name of Program Accreditation.
(b) Type of evidence-based practice.
(c) Type of practice-based model.
(4) Attach the Alcohol/Substance Abuse Work Plan.
IHS Urban Grant FY 2013 Work Plan
[Alcohol/Substance Abuse Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Data source for
Objectives Service or program Target population Process measure Outcome measures measures
--------------------------------------------------------------------------------------------------------------------------------------------------------
What are you trying to What type of program do Who do you hope to What information will you What information Where will you find
accomplish? you propose? serve in your collect about the will you collect to the information
program? program activities? find out the you collect?
results of your
program?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To prevent substance abuse among Community-based substance American Indian of youth Incidence/prevalence Medical records,
urban American Indian youth. abuse prevention youth ages 5-18 completing the of substance abuse/ RPMS behavioral
curriculum. years old. curriculum, of dependence. health package,
sessions conducted, National Youth
of staff Survey.
trained.
To prevent substance abuse and After school, summer, and American Indian of youth Incidence of Charts, RPMS
related problems. weekend activities (e.g. youth ages 5-14 completing community- substance abuse, behavioral health
outdoor experiential years old. based sessions, of parents completing negative and Youth Survey.
classroom based problem community-based positive attitudes
solving activities). sessions, of and behaviors,
community-based sessions. incidence of peer
drug use.
[[Page 48450]]
Reduce drug use and increase Matrix model for American Indian of clients Incidence of drug Medical records,
treatment retention. outpatient treatment. adult completing program, use, increase or RPMS behavioral
methamphetamine of relapse decrease in health package,
clients. prevention sessions, treatment Addiction Severity
of family and retention, positive Index, results of
group therapies, of drug education samples.
sessions, of
self-help groups, of urine tests.
--------------------------------------------------------------------------------------------------------------------------------------------------------
4. MENTAL HEALTH SERVICES
Program Narrative and Work Plan
Use the alcohol/substance abuse program narrative description
template to develop the Mental Health Services program narrative.
Attach the UIHP Mental Health Services Work Plan.
IHS Urban Grant FY 2013 Work Plan
[Mental Health Program Sample Work Plan]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Data source for
Objectives Service or program Target population Process measure Outcome measures measures
--------------------------------------------------------------------------------------------------------------------------------------------------------
What are you trying to What type of program do Who do you hope to What information will you What information Where will you find
accomplish? you propose? serve in your collect about the will you collect to the information
program? program activities? find out the you collect?
results of your
program?
--------------------------------------------------------------------------------------------------------------------------------------------------------
To promote mental health......... American Indian Life American Indian of youth Feelings of Medical records,
Skills Development youth ages 13-17 completing the hopelessness, RPMS behavioral
curriculum. years old. curriculum, of problem solving health package,
sessions conducted, skills. Beck Hopelessness
of teachers Scale, problem
trained, number of solving skills.
community resource
leaders trained.
Improve the mental health of Home-based, community- American Indian of individual, Reduced child Medical records,
American Indian children and based, and office-based children and their couples, group, and involvement in RPMS behavioral
their families. mental health counseling. families needing family counseling juvenile justice health package
services from our sessions, of and child welfare, coping skill
community-based home, community, and improved coping measure, report
program. office-based visits. skills, improved cards, attendance
school attendance records.
and grades.
[[Page 48451]]
Reduce symptoms related to trauma Mental health counseling American Indian of individual, Incidence of Post- Self-report PTSD,
with cognitive adults. couples, group, and Traumatic Stress Beck Depression
behavioral therapy family counseling Disorder (PTSD) Inventory, coping
intervention and sessions, of symptoms, incidence skills measure,
historical trauma historical trauma of depression, peer and family
intervention. groups, of increased coping support measure,
adults counseled. skills, increased medical records,
peer and family RPMS behavioral
support. health package.
--------------------------------------------------------------------------------------------------------------------------------------------------------
RPMS Suicide Reporting Form
Instructions for Completing
This form is intended as a data collection tool only. It does not
replace documentation of clinical care in the medical record and it is
not a referral form. HRN, Date of Act and Provider Name are required
fields. If the information requested is not known or not listed as an
option, choose ``Unknown'' or ``Other'' (with specification) as
appropriate. The form can be partially completed, saved and completed
at a later time if needed.
LOCAL CASE NUMBER:
Indicate internal tracking number if used, not required.
DATE FORM COMPLETED:
Indicate the date the Suicide Reporting Form was completed.
PROVIDER NAME:
Record the name of Provider completing the form.
DATE OF ACT:
Record Date of Act as mm/dd/yy. If exact day is unknown, use the
month, 1st day of the month (or another default day), year. If exact
date of act is unknown, all providers should use the same default day
of the month.
HEALTH RECORD NUMBER:
Record the patient's health record number.
DOB/AGE:
Record Date of Birth as mm/dd/yy and patient's age.
SEX:
Indicate Male or Female.
COMMUNITY WHERE ACT OCCURRED:
Record the community code or the name, county and state of the
community where the act occurred.
EMPLOYMENT STATUS:
Indicate patient's employment status, choose one.
RELATIONSHIP STATUS:
Indicate patient's relationship status, choose one.
EDUCATION:
Select the highest level of education attained and if less than a
High School graduate, record the highest grade completed. Choose one.
SUICIDAL BEHAVIOR:
Identify the self-destructive act, choose one. Generally, the
threshold for reporting should be ideation with intent and plan, or
other acts with higher severity, either attempted or completed.
LOCATION OF ACT:
Indicate location of act, choose one.
PREVIOUS ATTEMPTS:
Indicate number of previous suicide attempts, choose one.
METHOD:
Indicate method used. Multiple entries are allowed, check all that
apply. Describe methods not listed.
SUBSTANCE USE INVOLVED:
If known, indicate which substances the patient was under the
influence of at the time of the act. Multiple entries allowed, check
all that apply. List drugs not shown.
CONTRIBUTING FACTORS:
Multiple entries allowed, check all that apply. List contributing
factors not shown.
DISPOSITION:
Indicate the type of follow-up planned, if known.
NARRATIVE:
Record any other relevant clinical information not included above.
Last Updated 10/25/12
BILLING CODE 3510-22-P
[[Page 48452]]
[GRAPHIC] [TIFF OMITTED] TN08AU13.003
[[Page 48453]]
[GRAPHIC] [TIFF OMITTED] TN08AU13.004
BILLING CODE 3510-22-C
C. PROJECT EVALUATION (15 Points)
1. Describe your evaluation plan. Provide a plan to determine the
degree to which objectives are met and methods are followed.
2. Describe how you will link program performance/services to
budget expenditures. Include a discussion of Uniform Data System (UDS)
and GPRA Report Measures here.
3. Include the following program specific information:
(a) Describe the expected feasibility and reasonable outcomes
(e.g., decreased drug use in those patients receiving services) and the
means by which you determined these targets or results.
(b) Identify dates of reviews by the internal staff to assess
efficacy:
(1) Assessment of staff adequacy.
(2) Assessment of current position descriptions.
(3) Assessment of impact on local community.
(4) Involvement of local community.
(5) Adequacy of community/governance board.
(6) Ability to leverage IHS funding to obtain additional funding.
(7) Additional IHS grants obtained.
(8) New initiatives planned for funding year.
(9) Customer satisfaction evaluations.
4. Quality Improvement Committee (QIC).
The UIHP QIC, a planned, organization-wide, interdisciplinary team,
systematically improves program performance as a result of its findings
regarding clinical, administrative and cost-of-care performance issues,
and actual patient care outcomes including the FY 2012 GPRA report and
2011 UDS report (results of care including safety of patients).
(a) Identify the QIC membership, roles, functions, and frequency of
meetings. Frequency of meetings shall be at least quarterly.
(b) Describe how the results of the QIC reviews provide regular
feedback to the program and community/governance board to improve
services.
(1) September 1, 2013-March 31, 2014 activities planned.
(c) Describe how your facility is integrating the improving patient
care model into your health delivery structure:
(1) Identify specific measures you are tracking as part of the
Improvements in Patient Care (IPC) work.
(2) Identify community members that are part of your IPC team.
(3) Describe progress meeting your program's goals for the use of
the IPC model within your healthcare delivery model.
D. PROGRESS REPORT: ORGANIZATIONAL CAPABILITIES AND QUALIFICATIONS (10
Points)
This section outlines the broader capacity of the organization to
complete the project outlined in the application and program specific
work plans. This section includes the identification of personnel
responsible for completing tasks and the chain of responsibility for
successful completion of the project outlined in the work plans.
1. Describe the organizational structure with a current approved
one page organizational chart that shows the board of directors, key
personnel, and staffing. Key personnel positions include the Chief
Executive Officer or Executive Director, Chief Financial Officer,
Medical Director, and Information Officer.
2. Describe the board of directors that is fully and legally
responsible for operation and performance of the 501(c)(3) non-profit
urban Indian organization:
(a) List all current board members by name, sex, and Tribe or race/
ethnicity.
(b) Indicate their board office held.
(c) Indicate their occupation or area of expertise.
(d) Indicate if the board member uses the UIHP services.
(e) Indicate if the board member lives in the health service area.
(f) Indicate the number of years of continuous service.
(g) Indicate number of hours of Board of Directors training
provided, training dates and attach a copy of the Board of Directors
training curriculum.
3. List key personnel who will work on the project.
(a) Identify existing key personnel and new program staff to be
hired.
(b) For all new key personnel only include position descriptions
and resumes in the appendix. Position descriptions should clearly
describe each position and duties indicating desired qualifications,
experience, and requirements related to the proposed project and how
they will be supervised. Resumes must indicate that the proposed staff
member is qualified to carry out the proposed project activities and
who will determine if the work of a contractor is acceptable.
(c) Identify who will be writing the progress reports.
(d) Indicate the percentage of time to be allocated to this project
and identify the resources used to fund the remainder of the
individual's salary if personnel are to be only partially funded by
this grant.
E. CATEGORICAL BUDGET AND BUDGET JUSTIFICATION (5 Points)
This section should provide a clear estimate of the project program
costs and justification for expenses for the
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budget period September 1, 2013-March 31, 2014. The budget and budget
justification should be consistent with the tasks identified in the
work plan.
1. Categorical Budget (Form SF 424A, Budget Information Non-
Construction Programs).
(a) Provide a narrative justification for all costs, explaining why
each line item is necessary or relevant to the proposed project.
Include sufficient details to facilitate the determination of cost
allowability.
(b) If indirect costs are claimed, indicate and apply the current
negotiated rate to the budget. Include a copy of the current rate
agreement in the appendix.
V. Award Administration Information
Reporting Requirements
Failure to submit required reports within the time allowed may
result in suspension or termination of an active agreement, 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 one
or both of the following: (1) The imposition of special award
provisions; and (2) the non-funding or non-award of other eligible
projects or activities. This requirement applies whether the
delinquency is attributable to the failure of the organization or the
individual responsible for preparation of the reports.
The reporting requirements for this program are noted below:
A. Program Progress Report
Program progress reports are required quarterly. These reports will
include a brief comparison of actual program accomplishments to the
goals established for the period, reasons for slippage (if applicable),
and other pertinent information as required. A final program report
must be submitted within 90 days of expiration of the budget/project
period.
B. Financial Report
Federal Financial Report, (FFR-SF-425), Cash Transaction Reports
are due every calendar quarter to the Division of Payment Management,
Payment Management Branch, HHS at: https://www.dpm.psc.gov. Failure to
submit timely reports may cause a disruption in timely payments to your
organization.
Grantees are responsible and accountable for accurate information
being reported on all required reports; the Progress Reports, and
Federal Financial Report.
C. Federal Subaward Reporting System (FSRS)
This award may be subject to the Transparency Act subaward and
executive compensation reporting requirements of 2 CFR part 170.
The Transparency Act requires the Office of Management and Budget
(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
subawards and executive compensation under Federal assistance awards.
IHS has implemented a Term of Award into all IHS Standard Terms and
Conditions, NoAs and funding announcements regarding the FSRS reporting
requirement. This IHS Term of Award is applicable to all IHS grant and
cooperative agreements issued on or after October 1, 2010, with a
$25,000 subaward obligation dollar threshold met for any specific
reporting period. Additionally, all new (discretionary) IHS awards
(where the project period is made up of more than one budget period)
and where: (1) The project period start date was October 1, 2010 or
after and (2) the primary awardee will have a $25,000 subaward
obligation dollar threshold during any specific reporting period will
be required to address the FSRS reporting. For the full IHS award term
implementing this requirement and additional award applicability
information, visit the Grants Management Grants Policy Web site at:
https://www.ihs.gov/dgm/index.cfm?module=dsp_dgm_policy_topics.
D. Annual Audit Report
In accordance with 25 U.S.C. 1657, the reports and records of the
urban Indian organization with respect to a contract or grant under
subchapter IV, shall be subject to audit by the Secretary, Department
of Health and Human Services and the Comptroller General of the United
States.
The Secretary shall allow as a cost to any contract or grant
entered into under section 1653 of this title the cost of an annual
private audit conducted by a certified public accountant.
E. GPRA Report
GPRA reports are required quarterly. These reports are submitted to
the IHS Area GPRA Coordinator. RPMS users must use CRS for reporting.
Non-RPMS users must use the interface system to transfer data from
their current data system to RPMS for CRS reporting.
F. Quarterly Immunization Report
Immunization reports are required quarterly. These reports are
submitted to the IHS Area Immunization Coordinator.
G. Unmet Needs Report
An unmet needs report is required quarterly. These reports will
include information gathered to: (1) Identify gaps between unmet health
needs of urban Indians and the resources available to meet such needs;
and (2) make recommendations to the Secretary and Federal, State,
local, and other resource agencies on methods of improving health
service programs to meet the needs of urban Indians.
VI. Agency Contacts
1. Questions on the programmatic issues may be directed to: Phyllis
Wolfe, Director, Office of Urban Indian Health Programs, 801 Thompson
Avenue, Suite 200, Rockville, MD 20852, 301-443-1631,
Phyllis.wolfe@ihs.gov.
2. Questions on grants management and fiscal matters may be
directed to: Pallop Chareonvootitam, Grants Management Specialist, 801
Thompson Avenue, Suite 100, Rockville, MD 20852, 301-443-2195,
Pallop.chareonvootitam@ihs.gov.
3. Questions on systems matters may be directed to: Paul Gettys,
Grant Systems Coordinator, 801 Thompson Avenue, TMP Suite 360,
Rockville, MD 20852, Phone: 301-443-2114; or the DGM main line 301-443-
5204, Fax: 301-443-9602, Email: Paul.Gettys@ihs.gov.
VII. Other Information
The Public Health Service strongly encourages all grant and
contract recipients to provide a smoke-free workplace and promote 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.
Date: July 31, 2013.
Yvette Roubideaux,
Acting Director, Indian Health Service.
[FR Doc. 2013-19113 Filed 8-7-13; 8:45 am]
BILLING CODE 4165-16-P