Preventing Alcohol-Related Deaths Through Social Detoxification, 12956-12964 [2023-04151]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 88, Number 40 (Wednesday, March 1, 2023)]
[Notices]
[Pages 12956-12964]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-04151]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Preventing Alcohol-Related Deaths Through Social Detoxification

    Announcement Type: New.
    Funding Announcement Number: HHS-2023-IHS-PARD-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.654.

Key Dates

    Application Deadline Date: March 31, 2023.
    Earliest Anticipated Start Date: April 17, 2023.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS), Office of Clinical and Preventive 
Services, Division of Behavioral Health (DBH) is accepting applications 
for cooperative agreements for the Preventing Alcohol-Related Deaths 
(PARD) through Detoxification. This program is authorized under the 
Snyder Act, 25 U.S.C. 13; Consolidated Appropriations Act, 2023, Public 
Law 117-328, 136 Stat. 4459 (2022); and the Transfer Act, 42 U.S.C. 
2001(a). This program is described in the Assistance Listings located 
at https://sam.gov/content/home (formerly known as the CFDA) under 
93.654.

Background

    According to the Centers for Disease Control and Prevention (CDC) 
mortality data (Centers for Disease Control and Prevention, National 
Center for Health Statistics. National Vital Statistics System, 
Mortality 1999-2020 on CDC WONDER Online Database, released in 2021), 
alcohol related deaths among American Indian and Alaska Native (AI/AN) 
persons is a significant and persistent tragic outcome in the US. From 
2016 to 2020, the crude rates for alcohol-related deaths was 51.9 (per 
100,000) for AI/AN persons, nearly five times higher than non-AI/AN 
persons (11.7 per 100,000). The geography of these deaths is telling, 
as 48% were in a cluster across Arizona and New Mexico. Twenty of those 
counties have death rates over the 51.9 national rate. The highest 
rates were within McKinley County, with a 147.7 crude death rate for 
AI/AN persons--nearly 13 times higher than the rate for non-AI/AN, 
nationally. In the most recent PARD grant program (2017-2022, https://www.gpo.gov/fdsys/pkg/FR-2017-08-14/pdf/2017-17102.pdf), the estimated 
alcohol-related crude death rates in the proximities of the previous 
project sites (https://www.ihs.gov/sites/asap/themes/responsive2017/display_objects/documents/pardawardsbystate2017.pdf), McKinley County, 
New Mexico (Gallup City project) and Oglala Lakota County, South Dakota 
(formerly Shannon County), remain notably high. With this opportunity, 
in coordination with the PARD awardee, IHS will address increasing the 
clinical capacity of services offered between the awardee and local 
continuum of services.

Purpose

    The purpose of this program is to increase access to community-
based prevention strategies that provide social detoxification, 
evaluation, stabilization, fostering patient readiness for and entry 
into treatment for alcohol use, and other substance use disorders In 
alignment with the IHS 2019-2023 Strategic Plan Goal 1: To ensure that 
comprehensive, culturally appropriate personal and public health 
services are available and accessible to AI/AN people, the PARD project 
is designed to provide communities the ability to reduce alcohol-
related mortality and encourage clients to seek additional alcohol and/
or substance use disorder treatment after discharge from a 
detoxification program.
    IHS will use this funding to focus on the provision of services in 
Tribal and Urban Indian communities with the highest burden of alcohol-
related deaths among AI/AN persons. IHS analyzed the national rates of 
causes of deaths using the CDC data (Centers for Disease Control and 
Prevention, National Center for Health Statistics. National Vital 
Statistics System, Mortality 1999-2020 on CDC WONDER Online Database, 
released in 2021), and determined that McKinley County, New Mexico 
(with the largest city of Gallup), continues to have the highest burden 
of alcohol-related deaths among AI/AN persons. Additionally, the 2017 
Senate Appropriations Committee Report 114-281 expressed the 
Committee's expectation that IHS address alcohol and substance abuse 
through Federal, State, local, and tribal partners, calling for a 
sustainable model for life-saving community services, with specific 
attention on the capabilities of the Na'Nizhoozhi Center in Gallup, New 
Mexico.
    A consensus among clinical and subject matter experts understand 
detoxification does not provide the full spectrum of alcohol and/or 
substance use disorder treatment but can serve as a pathway to seeking 
treatment and as a component in the continuum of services for alcohol 
and substance use disorders (Substance Abuse and Mental Health Services 
Administration (SAMHSA) Treatment Improvement Protocol (TIP) 45 
(https://www.samhsa.gov/resource/ebp/tip-45-detoxification-substance-abuse-treatment).

Required Activities

    The PARD program requires applicants to review the Substance Abuse 
and Mental Health Services

[[Page 12957]]

Administration (SAMHSA) Treatment Improvement Protocol (TIP) 45 
(https://www.samhsa.gov/resource/ebp/tip-45-detoxification-substance-abuse-treatment), which identifies the principle for the basis of the 
TIP. The PARD program must include the three critical components--
evaluation, stabilization, and fostering patient readiness for and 
entry into treatment. The three critical components identified in the 
SAMHSA TIP 45 will serve as the program objectives that each applicant 
will be required to meet. The three objectives include:
    1. To evaluate clients encountering the detoxification program by 
the following methods:
    a. testing for the presence of substances of use either through the 
bloodstream, urine or saliva tests, breathalyzers, and visually; and,
    b. measuring the client's coordination and concentration; and,
    c. screening for co-occurring mental and physical conditions; and
    d. may include a comprehensive assessment of the client's medical 
and psychological conditions, social situations, and historical 
traumas.
    The evaluation serves as the basis for the initial treatment plan 
once a client has been withdrawn successfully.
    2. To stabilize the clients while in detoxification, which includes 
the following methods:
    a. The medical and psychosocial processes of assisting the client 
through acute intoxication and withdrawal to the attainment of a 
medically stable, fully supported, substance-free state. This may be 
done with the assistance of medications, though in some approaches, no 
medication is used.
    b. Familiarizing patients with their role and what to expect in the 
detoxification program.
    c. The detoxification staff seek the involvement of the client's 
social support systems (family, employers, significant others, 
congregations, etc.-- with release of confidentiality).
    d. Provide hot meals, showers, hygiene kits, and other activities 
of daily living that are necessary for individuals in detoxification 
and treatment services.
    e. Ensure evidence-based interventions, promising/best practices, 
and culture-based practices are incorporated into the detoxification 
curriculum while individuals are participating in services.
    3. To foster the client's readiness for and entry into treatment 
for alcohol use disorders, and when appropriate, other substance use 
disorders:
    a. Preparing the client for entry into alcohol and/or substance use 
disorder treatment by stressing the importance of following through 
with their complete continuum of care, as a documented treatment plan.
    b. It is highly recommended to encourage clients to continue 
alcohol and/or substance use disorder treatment prior to discharge from 
the detoxification program, and record the commitment that is indicated 
by the client in their documented treatment plan.
    c. Provide recovery pathways for all clients (recorded in their 
respective documented treatment plans) by linking them to further 
treatment for alcohol and/or substance use disorders, including the 
facilitation of contact with treatment providers and programs after 
detoxification.
    d. Measure the overall treatment process, including the progress 
and results of referrals, by following individuals who enter the 
detoxification program and throughout their follow-on uses of alcohol 
and/or substance use disorder treatment/rehabilitation after 
detoxification, and record the results in their respective treatment 
plans.
    The IHS encourages applicants to develop and submit a work plan 
that emphasizes cross-system collaboration, the inclusion of family and 
social support systems, community resources, and culturally appropriate 
approaches.
    Grantees will be required to:
    (1) Review and implement the guidance of the SAMHSA TIP 45, 
Detoxification and Substance Abuse Treatment.
    (2) Provide semi-annual reports to the IHS program officer on the 
number of individuals served, number of individuals referred to 
treatment services, number of individuals who access services more than 
once, and number of individuals who access safe housing options.
    (3) Collect data that accounts for all the interventions provided 
to each patient in a format that measures operationally defined 
methods, content, and dose.
    (4) The data collected must account for the service transitions for 
each patient (e.g., transfer to the emergency room, transfer to 
detoxification) in the local continuum of care.
    (5) The data collected must account for the outcomes for each 
patient (e.g., incarceration, inpatient treatment, sobriety, moved out 
of service area, missing, and death).
    (6) The complete patient-level data, de-identified, will be 
securely transferred by the awardee to the IHS DBH National Data 
Coordinator every quarter, for independent and nationally comparative 
analysis.
    (7) Participate in the development, implementation, and evaluation 
of a strategy that prevents alcohol related death.
    (8) Participate in the development, implementation, and evaluation 
of a sustainable model for clinical capacity.
    (9) Provide annual reports on successes and challenges.
    (10) Host annual site visits for IHS officials to discuss progress, 
partnerships, clinical capacity, challenges, and opportunities for 
improvement.
    (11) Provide meals, showers, hygiene kits, and other activities of 
daily living that are necessary for individuals in detoxification and 
treatment services. The meals should only be provided while the patient 
is in the detoxification program to ensure proper nutrition and safety 
for the patient.
    (12) Ensure coordination with cultural services and traditional 
healers to provide services while individuals are participating in 
services.
    (13) If applicable, provide transportation to and from medical 
appointments or for medical clearance and ensure that medication 
management is offered while individuals are participating in services.
    (14) Must use 100 percent of IHS award funds for services provided 
to AI/AN individuals.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total amount of funding identified for the first budget year, 
starting in fiscal year (FY) 2023 is approximately $2 million. The 
amount of funding available for competing and subsequent continuation 
awards issued under this announcement is subject to the availability of 
appropriations and budgetary priorities of the Agency. The IHS is under 
no obligation to make awards that are selected for funding under this 
announcement.
Anticipated Number of Awards
    Approximately one award will be issued under this program 
announcement.
Period of Performance
    The project period is for 5 years.
Cooperative Agreement
    Cooperative agreements awarded by the Department of Health and 
Human Services (HHS) are administered under the same policies as 
grants. However, the funding agency, IHS, is anticipated to have 
substantial programmatic

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involvement in the project during the entire period of performance. 
Below is a detailed description of the level of involvement required of 
the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
    (1) Participate in community-level meetings with key stakeholders 
who will develop a strategy to combat the issue of alcohol use 
disorders and subsequent alcohol-related deaths.
    (2) Participate in annual site visits for technical assistance on 
increasing the clinical capacity of services offered between the 
awardee and IHS programs, where available.
    (3) Provide subject matter expertise on policies, procedures, 
guidelines, and other services provided by the grantee.
    (4) Provide guidance to the awardee involving strategy, data 
collection, analysis, reporting, coordination of activities, and 
evaluation.
    (5) Provide medical services as appropriate for individuals 
requiring a higher level of care, or medical clearance.
    (6) Monitor the overall progress and challenges of the awardee's 
program and their adherence to the terms and conditions of the 
cooperative agreement.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity an applicant will be a 
public or private institution operated by a state, local, Tribal, or 
private entity that operates direct, on-site alcohol and/or substance 
use disorder treatment services, including social alcohol 
detoxification services, to AI/AN persons. For purposes of this 
announcement, ``institution'' means an entity that provides substance 
use disorder treatment services including detoxification. Applicants 
must be able to start services on the first day of the award. 
Applicants must serve AI/AN persons.
    The Division of Grants Management (DGM) will notify any applicants 
deemed ineligible.

    Note:  Please refer to Section IV.2 (Application and Submission 
Information/Subsection 2, Content and Form of Application 
Submission) for additional proof of applicant status documents 
required, such as Tribal Resolutions, proof of nonprofit status, 
etc.

2. Cost Sharing or Matching

    The IHS does not require matching funds or cost sharing for grants 
or cooperative agreements.

3. Other Requirements

    Applications with budget requests that exceed the highest dollar 
amount outlined under Section II Award Information, Estimated Funds 
Available, or exceed the period of performance outlined under Section 
II Award Information, Period of Performance, are considered not 
responsive and will not be reviewed. If deemed ineligible, IHS will not 
return the application. The applicant will be notified by email by the 
Division of Grants Management (DGM) of this decision.
Additional Required Documentation
Proof of Nonprofit Status
    Organizations claiming nonprofit status must submit a current copy 
of the 501(c)(3) Certificate with the application, by the Application 
Deadline Date listed under the Key Dates section on page 1 of this 
announcement.
    An applicant submitting any of the above additional documentation 
after the initial application submission due date is required to ensure 
the information was received by the IHS DGM by obtaining documentation 
confirming delivery (i.e., FedEx tracking, postal return receipt, 
etc.).

IV. Application and Submission Information

    Grants.gov uses a Workspace model for accepting applications. The 
Workspace consists of several online forms and three forms in which to 
upload documents--Project Narrative, Budget Narrative, and Other 
Documents. Give your files brief descriptive names. The filenames are 
key in finding specific documents during the objective review and in 
processing awards. Upload all requested and optional documents 
individually, rather than combining them into a single file. Creating a 
single file creates confusion when trying to find specific documents. 
Such confusion can contribute to delays in processing awards, and could 
lead to lower scores during the objective review.

1. Obtaining Application Materials

    The application package and detailed instructions for this 
announcement are available at https://www.Grants.gov.
    Please direct questions regarding the application process to 
[email protected].

2. Content and Form Application Submission

    Mandatory documents for all applicants include:
     Application forms:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
    4. Project Abstract Summary form.
     Project Narrative (not to exceed 10 pages). See Section 
IV.2.A, Project Narrative for instructions.
     Budget Narrative (not to exceed 5 pages). See Section 
IV.2.B, Budget Narrative for instructions.
     Letters of Support from organization's Board of Directors, 
Tribal partners, and community stakeholders.
     501(c)(3) Certificate (if applicable).
     Biographical sketches for all key personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Organizational Chart (optional).
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    1. Email confirmation from Federal Audit Clearinghouse (FAC) that 
audits were submitted; or
    2. Face sheets from audit reports. Applicants can find these on the 
FAC website at https://facdissem.census.gov/.
Public Policy Requirements
    All Federal public policies apply to IHS grants and cooperative 
agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be 
deemed subjected to discrimination by reason of their exclusion from 
benefits limited by Federal law to individuals eligible for benefits 
and services from the IHS. See https://www.hhs.gov/grants/grants/grants-policies-regulations/.
Requirements for Project and Budget Narratives
    A. Project Narrative: This narrative must be a separate document 
that is no more than 10 pages and must: (1) have consecutively numbered 
pages; (2) use black font 12 points or larger (applicants may use 10 
point font for tables); (3) be single-spaced; and (4) be formatted to 
fit standard letter paper (8\1/2\ x 11 inches). Do not combine this 
document with any others.
    Be sure to succinctly answer all questions listed under the 
evaluation criteria (refer to Section V.1, Evaluation Criteria), and 
place all responses and required information in the correct

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section noted below or they will not be considered or scored. If the 
narrative exceeds the overall page limit, reviewers will be directed to 
ignore any content beyond the page limit. The 10-page limit for the 
project narrative does not include the standard forms, budget, budget 
narratives, and/or other items. Page limits for each section within the 
project narrative are guidelines, not hard limits.
    There are three parts to the project narrative:

Part 1--Program Information;
Part 2--Program Planning and Evaluation; and
Part 3--Program Report.

    See below for additional details about what must be included in the 
narrative.
    The page limits below are for each narrative and budget submitted.
Part 1: Program Information (Limit--2 Pages)
    Section 1: Needs.
    Describe the current issue of alcohol use disorders, alcohol-
related deaths, and rates of alcohol-related liver cirrhosis, as well 
as other social and health issues impacted by alcohol-related deaths. 
Describe the program's current social detoxification program, who 
operates it, number of employees, how long it has been operating, and 
what programs or services are currently being provided. Provide a 
statement of fact on the clientele served, average daily census, and 
ratio of individuals served who are enrolled members of federally 
recognized Tribes to those who are not.
Part 2: Program Planning and Evaluation (Limit--6 Pages)
    Section 1: Program Plans.
    Describe fully and clearly the direction the applicant plans to 
take to provide detoxification services, including the three critical 
components: evaluation, stabilization, and fostering patient readiness 
for and entry into treatment. Describe how the applicant will provide 
safe housing and custodial care in a safe environment by employees who 
have successfully passed background checks, who have been trained in 
social detoxification, and who are familiar with the features of 
substance use withdrawal, have training in basic life support, and have 
access to emergency medical systems. Describe how the applicant will 
provide appropriate monitoring and security to prevent self-harm of 
served individuals and harm to others. Describe how the applicant has 
the ability to provide transportation to and from emergency 
departments, as needed. Further information on general guidelines for 
addressing these needs can be found in the SAMHSA TIP-45.
    Describe fully and clearly the types of community partnerships and 
referral providers to provide health and behavioral health treatment 
services, among others. Include information about how the applicant 
will implement a communication and support strategy that includes 
family members of individuals served (with their consent). Describe the 
applicant's ability to provide daily activities of living such as 
exercise, showers, meals, personal hygiene, blankets, and appropriate 
clothing. Include information on how the applicant will provide 
culturally appropriate interventions and activities. Provide details on 
nurse support for medical issues and medication management and referral 
to a higher level of care, when needed; medication management, 
assessments, and screening of clients; and case management services.
    Section 2: Program Evaluation.
    This section of the project narrative should describe your 
organization's plan for gathering client-specific non-identifiable 
data, submitting data requirements, and documenting the ability to 
ensure accurate digital data collection and reporting on community and 
client level activities, including those that correspond to treatment 
plans. The applicant should describe how their program intends to 
evaluate its activities to include successes, challenges, outputs, and 
outcomes. Some examples of activities include training of staff on 
observation and signs to look for in clients encountering the 
detoxification program; safety protocols; organizational protocols and 
procedures; safety plans; data collection methods and support systems 
for collecting data; partnerships developed and sustained; and recovery 
support activities provided for clients.
Part 3: Program Report (Limit--2 Pages)
    Section 1: Describe your organization's significant program 
activities and accomplishments as a detoxification program over the 
past 5 years associated with the goals of this announcement. Please 
identify current staffing and key personnel who will be responsible for 
the management of the cooperative agreement.
    Additionally, the applicant's should describe their ability to 
report on collaboration and networking with local partners. Reporting 
elements will pertain to activities, processes, barriers, and outcomes 
and include any partners who will assist in evaluation efforts if 
separate from the primary applicant.
B. Budget Narrative (Limit--5 Pages)
    Provide a budget narrative that explains the amounts requested for 
each line item of the budget from the SF-424A (Budget Information for 
Non-Construction Programs) for the first year of the project. The 
applicant can submit with the budget narrative a more detailed 
spreadsheet than is provided by the SF-424A (the spreadsheet will not 
be considered part of the budget narrative). The budget narrative 
should specifically describe how each item will support the achievement 
of proposed objectives. Be very careful about showing how each item in 
the ``Other'' category is justified. Do NOT use the budget narrative to 
expand the project narrative.

3. Submission Dates and Times

    Applications must be submitted through Grants.gov by 11:59 p.m. 
Eastern Time on the Application Deadline Date. Any application received 
after the application deadline will not be accepted for review. 
Grants.gov will notify the applicant via email if the application is 
rejected.
    If technical challenges arise and assistance is required with the 
application process, contact Grants.gov Customer Support (see contact 
information at https://www.Grants.gov). If problems persist, contact 
Mr. Paul Gettys, Deputy Director, DGM, by email at [email protected]. Please 
be sure to contact Mr. Gettys at least 10 days prior to the application 
deadline. Please do not contact the DGM until you have received a 
Grants.gov tracking number. In the event you are not able to obtain a 
tracking number, call the DGM as soon as possible.
    The IHS will not acknowledge receipt of applications.

4. Intergovernmental Review

    Executive Order 12372 requiring intergovernmental review is not 
applicable to this program.

5. Funding Restrictions

     Pre-award costs are allowable up to 90 days before the 
start date of the award provided the costs are otherwise allowable if 
awarded. Pre-award costs are incurred at the risk of the applicant.
     The available funds are inclusive of direct and indirect 
costs.
     Only one cooperative agreement under this program may be 
awarded per applicant.

6. Electronic Submission Requirements

    All applications must be submitted via Grants.gov. Please use the 
https://www.Grants.gov website to submit an application. Find the 
application by

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selecting the ``Search Grants'' link on the homepage. Follow the 
instructions for submitting an application under the Package tab. No 
other method of application submission is acceptable.
    If you cannot submit an application through Grants.gov, you must 
request a waiver prior to the application due date. You must submit 
your waiver request by email to [email protected], with a copy to Mr. Paul 
Gettys, Deputy Director, DGM, at [email protected]. Your waiver 
request must include clear justification for the need to deviate from 
the required application submission process. The IHS will not accept 
any applications submitted through any means outside of Grants.gov 
without an approved waiver.
    If the DGM approves your waiver request, you will receive a 
confirmation of approval email containing submission instructions. You 
must include a copy of the written approval with the application 
submitted to the DGM. Late applications or application that do not 
include a copy of the signed waiver from the Deputy Director of the DGM 
will not be reviewed. The Grants Management Officer of the DGM will 
notify the applicant via email of this decision. Applications submitted 
under waiver must be received by the DGM no later than 5:00 p.m. 
Eastern Time on the Application Deadline Date. Late applications will 
not be accepted for processing. Applicants that do not register for 
both the System for Award Management (SAM) and Grants.gov and/or fail 
to request timely assistance with technical issues will not be 
considered for a waiver to submit an application via alternative 
method.
    Please be aware of the following:
     Please search for the application package in https://www.Grants.gov by entering the Assistance Listing (CFDA) number or the 
Funding Opportunity Number. Both numbers are located in the header of 
this announcement.
     If you experience technical challenges while submitting 
your application, please contact Grants.gov Customer Support (see 
contact information at https://www.Grants.gov).
     Upon contacting Grants.gov, obtain a tracking number as 
proof of contact. The tracking number is helpful if there are technical 
issues that cannot be resolved and a waiver from the agency must be 
obtained.
     Applicants are strongly encouraged not to wait until the 
deadline date to begin the application process through Grants.gov as 
the registration process for SAM and Grants.gov could take up to 20 
working days.
     Please follow the instructions on Grants.gov to include 
additional documentation that may be requested by this funding 
announcement.
     Applicants must comply with any page limits described in 
this funding announcement.
     After submitting the application, you will receive an 
automatic acknowledgment from Grants.gov that contains a Grants.gov 
tracking number. The IHS will not notify you that the application has 
been received.
System for Award Management (SAM)
    Organizations that are not registered with SAM must access the SAM 
online registration through the SAM home page at https://sam.gov. 
Organizations based in the U.S. will also need to provide an Employer 
Identification Number from the Internal Revenue Service that may take 
an additional 2-5 weeks to become active. Please see SAM.gov for 
details on the registration process and timeline. Registration with the 
SAM is free of charge but can take several weeks to process. Applicants 
may register online at https://sam.gov.
Unique Entity Identifier
    Your SAM.gov registration now includes a Unique Entity Identifier 
(UEI), generated by SAM.gov, which replaces the DUNS number obtained 
from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS 
number.
    Check your organization's SAM.gov registration as soon as you 
decide to apply for this program. If your SAM.gov registration is 
expired, you will not be able to submit an application. It can take 
several weeks to renew it or resolve any issues with your registration, 
so do not wait.
    Check your Grants.gov registration. Registration and role 
assignments in Grants.gov are self-serve functions. One user for your 
organization will have the authority to approve role assignments, and 
these must be approved for active users in order to ensure someone in 
your organization has the necessary access to submit an application.
    The Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), requires all HHS awardees to report 
information on sub-awards. Accordingly, all IHS awardees must notify 
potential first-tier sub-awardees that no entity may receive a first-
tier sub-award unless the entity has provided its UEI number to the 
prime awardee 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.
    Additional information on implementing the Transparency Act, 
including the specific requirements for SAM, are available on the DGM 
Grants Management, Policy Topics web page at https://www.ihs.gov/dgm/policytopics/.

V. Application Review Information

    Possible points assigned to each section are noted in parentheses. 
The project narrative and budget narrative should include only the 
first year of activities. The project narrative should be written in a 
manner that is clear to outside reviewers unfamiliar with prior related 
activities of the applicant. It should be well organized, succinct, and 
contain all information necessary for reviewers to fully understand the 
project. Attachments requested in the criteria do not count toward the 
page limit for the narratives. Points will be assigned to each 
evaluation criteria adding up to a total of 100 possible points. Points 
are assigned as follows:

1. Evaluation Criteria

    The purpose of this funding opportunity is to support programs that 
provide detoxification for alcohol use disorders and when appropriate, 
other substance use disorders to address its impact in AI/AN 
populations and reduce the mortality associated with alcohol and other 
substance use. The applicant must describe fully and clearly the 
following areas.
A. Part 1: Program Information (40 Points)
    1. The impact of alcohol use disorders, alcohol-related deaths, 
alcohol-related morbidity, and other social and health issues 
attributed to alcohol and other substances in the community they serve.
    2. The status of the social detoxification program, who operates 
it, the number of employees, how long it has been in operation, and 
what programs or services are being provided.
    3. Demonstrate the need for funding and how the funding will 
complement, enhance, increase, and/or expand the services currently 
provided.
    4. The applicant's service population, clientele served, average 
daily census, and ratio of individuals served who are enrolled members 
of federally recognized Tribes to those who are not.
    5. The applicant's readiness and capacity to provide services on 
day one of the award.
    6. The applicant's staffing level, experience and education of 
staff, and key personnel who will manage the project.

[[Page 12961]]

B. Part 2: Program Planning and Evaluation (40 Points)
    Section 1: Program Planning.
    1. The applicant's description of the social detoxification program 
that includes the three critical components of evaluation, 
stabilization, and fostering patient readiness for and entry into 
treatment.
    2. The applicant's plans to provide safe housing, including 
custodial care in a safe environment.
    3. The applicant's process of ensuring employees have passed 
background checks and are trained in appropriate alcohol and substance 
use disorder identification; withdrawal management; emergency and 
crisis intervention training; evidence/culture-based interventions and 
best practices; and treatment approaches.
    4. The applicant's appropriate monitoring of individuals accessing 
services and security measures to ensure safety and prevention of self-
harm and harm to others.
    5. Community partnerships and referral networks for health and 
behavioral health treatment services, including when medical 
intervention is required for stabilization.
    6. The applicant's ability to provide transportation to and from 
emergency departments.
    7. Communication strategies with the client's support system that 
fosters the client's recovery efforts upon consent (i.e., family, 
social support groups, peer recovery specialists, and traditional 
healing services).
    8. The applicant's ability to provide activities for daily living 
including physical and mental exercises, showers, meals, cultural 
activities, blankets, appropriate clothing, and activities that foster 
increased self-esteem, self-awareness, and self-efficacy.
    9. The applicant's ability to provide clinical and behavioral 
health support for medical issues and medication management, 
assessments, screening, referral to higher levels of care, and case 
management.
    Section 2: Program Evaluation.
    10. The organization's plan for gathering client-specific non-
identifiable data.
    11. The ability to ensure accurate digital data collection and 
reporting on community and client level activities.
    12. The ability to report on networking and partnering with local 
partners through memorandums of agreements/understanding, letters of 
support, council/Tribal resolutions, and coalition involvement.
    13. The applicant should describe how their program intends to 
evaluate its activities to include successes, challenges, outputs, and 
outcomes.
C. Part 3: Program Report (10 Points)
    1. The applicant's significant program activities and 
accomplishments over the past 5 years associated with the goals of this 
funding opportunity.
    2. Identifies current staffing and key personnel who will be 
responsible for the management of the cooperative agreement.
    3. The applicant's ability to report on collaboration and 
networking with local partners and submit reporting elements that 
pertain to activities, processes, barriers, and outcomes.
    4. Include any partners who will assist in evaluation efforts if 
separate from the primary applicant.
D. Budget Narrative (10 Points)
    1. How clearly the applicant demonstrates each budget item aligns 
with its proposal and program approach.
    2. The degree to which the applicant budgets for evaluation 
activities.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Work plan, logic model, and/or timeline for proposed 
objectives.
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Rate Agreement.
     Organizational chart.
     Map of area identifying project location(s).
     Additional documents to support narrative (i.e., data 
tables, key news articles, etc.).

2. Review and Selection

    Each application will be prescreened for eligibility and 
completeness as outlined in the funding announcement. Applications that 
meet the eligibility criteria shall be reviewed for merit by the 
Objective Review Committee (ORC) based on evaluation criteria. 
Incomplete applications and applications that are not responsive to the 
administrative thresholds (budget limit, period of performance limit) 
will not be referred to the ORC and will not be funded. The program 
office will notify the applicant of this determination.
    Applicants must address all program requirements and provide all 
required documentation.

3. Notifications of Disposition

    All applicants will receive an Executive Summary Statement from the 
IHS DBH within 30 days of the conclusion of the ORC outlining the 
strengths and weaknesses of their application. The summary statement 
will be sent to the Authorizing Official identified on the face page 
(SF-424) of the application.
A. Award Notices for Funded Applications
    The Notice of Award (NoA) is the authorizing document for which 
funds are dispersed to the approved entities and reflects the amount of 
Federal funds awarded, the purpose of the award, the terms and 
conditions of the award, the effective date of the award, and the 
budget/project period. Each entity approved for funding must have a 
user account in GrantSolutions in order to retrieve the NoA. Please see 
the Agency Contacts list in Section VII for the systems contact 
information.
B. Approved but Unfunded Applications
    Approved applications not funded due to lack of available funds 
will be held for 1 year. If funding becomes available during the course 
of the year, the application may be reconsidered.

    Note:  Any correspondence, other than the official NoA executed 
by an IHS grants management official announcing to the project 
director that an award has been made to their organization, is not 
an authorization to implement their program on behalf of the IHS.

VI. Award Administration Information

1. Administrative Requirements

    Awards issued under this announcement are subject to, and are 
administered in accordance with, the following regulations and 
policies:
    A. The criteria as outlined in this program announcement.
    B. Administrative Regulations for Grants:
     Uniform Administrative Requirements, Cost Principles, and 
Audit Requirements for HHS Awards currently in effect or implemented 
during the period of award, other Department regulations and policies 
in effect at the time of award, and applicable statutory provisions. At 
the time of publication, this includes 45 CFR part 75, at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75.pdf.
     Please review all HHS regulatory provisions for 
Termination at 45 CFR 75.372, at the time of this publication located 
at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-sec75-372.pdf.
    C. Grants Policy:

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     HHS Grants Policy Statement, Revised January 2007, at 
https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.
    D. Cost Principles:
     Uniform Administrative Requirements for HHS Awards, ``Cost 
Principles,'' at 45 CFR part 75, subpart E, at the time of this 
publication located at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartE.pdf.
    E. Audit Requirements:
     Uniform Administrative Requirements for HHS Awards, 
``Audit Requirements,'' at 45 CFR part 75, subpart F, at the time of 
this publication located at https://www.govinfo.gov/content/pkg/CFR-2021-title45-vol1/pdf/CFR-2021-title45-vol1-part75-subpartF.pdf.
    F. As of August 13, 2020, 2 CFR part 200 was updated to include a 
prohibition on certain telecommunications and video surveillance 
services or equipment. This prohibition is described in 2 CFR 200.216. 
This will also be described in the terms and conditions of every IHS 
grant and cooperative agreement awarded on or after August 13, 2020. 
``If you are successful and receive a Notice of Award, in accepting the 
award, you agree that the award and any activities thereunder are 
subject to all provisions of 45 CFR part 75, currently in effect or 
implemented during the period of the award, other Department 
regulations and policies in effect at the time of the award, and 
applicable statutory provisions.''

2. Indirect Costs

    This section applies to all awardees that request reimbursement of 
IDC in their application budget. In accordance with HHS Grants Policy 
Statement, Part II-27, the IHS requires applicants to obtain a current 
IDC rate agreement and submit it to the DGM prior to the DGM issuing an 
award. The rate agreement must be prepared in accordance with the 
applicable cost principles and guidance as provided by the cognizant 
agency or office. A current rate covers the applicable grant activities 
under the current award's budget period. If the current rate agreement 
is not on file with the DGM at the time of award, the IDC portion of 
the budget will be restricted. The restrictions remain in place until 
the current rate agreement is provided to the DGM.
    Per 45 CFR 75.414(f) Indirect (F&A) costs,

any non-Federal entity (NFE) [i.e., applicant] that has never 
received a negotiated indirect cost rate, . . . may elect to charge 
a de minimis rate of 10 percent of modified total direct costs which 
may be used indefinitely. As described in Section 75.403, costs must 
be consistently charged as either indirect or direct costs, but may 
not be double charged or inconsistently charged as both. If chosen, 
this methodology once elected must be used consistently for all 
Federal awards until such time as the NFE chooses to negotiate for a 
rate, which the NFE may apply to do at any time.

    Electing to charge a de minimis rate of 10 percent only applies to 
applicants that have never received an approved negotiated indirect 
cost rate from HHS or another cognizant Federal agency. Applicants 
awaiting approval of their indirect cost proposal may request the 10 
percent de minimis rate. When the applicant chooses this method, costs 
included in the indirect cost pool must not be charged as direct costs 
to the grant.
    Available funds are inclusive of direct and appropriate indirect 
costs. Approved indirect funds are awarded as part of the award amount, 
and no additional funds will be provided.
    Generally, IDC rates for IHS awardees are negotiated with the 
Division of Cost Allocation at https://rates.psc.gov/ or the Department 
of the Interior (Interior Business Center) at https://ibc.doi.gov/ICS/tribal. For questions regarding the indirect cost policy, please call 
the Grants Management Specialist listed under ``Agency Contacts'' or 
write to [email protected].

3. Reporting Requirements

    The awardee must submit required reports consistent with the 
applicable deadlines. Failure to submit required reports within the 
time allowed may result in suspension or termination of an active 
grant, withholding of additional awards for the project, or other 
enforcement actions such as withholding of payments or converting to 
the reimbursement method of payment. Continued failure to submit 
required reports may result in the imposition of special award 
provisions and/or the non-funding or non-award of other eligible 
projects or activities. This requirement applies whether the 
delinquency is attributable to the failure of the awardee organization 
or the individual responsible for preparation of the reports. Per DGM 
policy, all reports must be submitted electronically by attaching them 
as a ``Grant Note'' in GrantSolutions. Personnel responsible for 
submitting reports will be required to obtain a login and password for 
GrantSolutions. Please use the form under the Recipient User section of 
https://www.grantsolutions.gov/home/getting-started-request-a-user-account/. Download the Recipient User Account Request Form, fill it out 
completely, and submit it as described on the web page and in the form.
    The reporting requirements for this program are noted below.
A. Progress Reports
    Program progress reports are required semi-annually. The progress 
reports are due within 30 days after the reporting period ends 
(specific dates will be listed in the NoA Terms and Conditions). These 
reports must include a brief comparison of actual accomplishments to 
the goals established for the period, a summary of progress to date or, 
if applicable, provide sound justification for the lack of progress, 
and other pertinent information as required. A final report must be 
submitted within 90 days of expiration of the period of performance.
B. Financial Reports
    Federal Financial Reports are due 90 days after the end of each 
budget period, and a final report is due 120 days after the end of the 
period of performance. Awardees are responsible and accountable for 
reporting accurate information on all required reports: the Progress 
Reports and the Federal Financial Report.
    Failure to submit timely reports may result in adverse award 
actions blocking access to funds.
C. Data Collection and Reporting
    All awardees will be required to collect and report data pertaining 
to activities, processes, and outcomes. The IHS DBH will provide 
guidance on data collection and reporting for evaluation purposes 
within 6 months of award. Programmatic reporting must be submitted 
within 30 days after the budget period ends for each project year 
(specific dates will be listed in the NoA Terms and Conditions). All 
reporting items will be submitted via the Grant Solutions. Technical 
assistance for web-based data entry will be timely and readily 
available to awardees by assigned IHS DBH staff. Awardees are 
responsible and accountable for accurate information being submitted by 
required due dates for Data Collection and Reporting.
D. Federal Sub-Award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The Transparency Act requires the OMB to establish a single 
searchable database, accessible to the public, with

[[Page 12963]]

information on financial assistance awards made by Federal agencies. 
The Transparency Act also includes a requirement for awardees of 
Federal grants to report information about first-tier sub-awards and 
executive compensation under Federal assistance awards.
    The IHS has implemented a Term of Award into all IHS Standard Terms 
and Conditions, NoAs, and funding announcements regarding the FSRS 
reporting requirement. This IHS Term of Award is applicable to all IHS 
grant and cooperative agreements issued on or after October 1, 2010, 
with a $25,000 sub-award obligation threshold met for any specific 
reporting period.
    For the full IHS award term implementing this requirement and 
additional award applicability information, visit the DGM Grants 
Management website at https://www.ihs.gov/dgm/policytopics/.
E. Non-Discrimination Legal Requirements for Awardees of Federal 
Financial Assistance
    The awardee must administer the project in compliance with Federal 
civil rights laws that prohibit discrimination on the basis of race, 
color, national origin, disability, age, and comply with applicable 
conscience protections. The awardee must comply with applicable laws 
that prohibit discrimination on the basis of sex, which includes 
discrimination on the basis of gender identity, sexual orientation, and 
pregnancy. Compliance with these laws requires taking reasonable steps 
to provide meaningful access to persons with limited English 
proficiency and providing programs that are accessible to and usable by 
persons with disabilities. The HHS Office for Civil Rights provides 
guidance on complying with civil rights laws enforced by HHS. See 
https://www.hhs.gov/civil-rights/for-providers/provider-obligations/ and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/.
     Recipients of FFA must ensure that their programs are 
accessible to persons with limited English proficiency. For guidance on 
meeting your legal obligation to take reasonable steps to ensure 
meaningful access to your programs or activities by limited English 
proficiency individuals, see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/ and https://www.lep.gov.
     For information on your specific legal obligations for 
serving qualified individuals with disabilities, including reasonable 
modifications and making services accessible to them, see https://www.hhs.gov/civil-rights/for-individuals/disability/.
     HHS funded health and education programs must be 
administered in an environment free of sexual harassment. See https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/.
     For guidance on administering your program in compliance 
with applicable Federal religious nondiscrimination laws and applicable 
Federal conscience protection and associated anti-discrimination laws, 
see https://www.hhs.gov/conscience/conscience-protections/ 
and https://www.hhs.gov/conscience/religious-freedom/.
F. Federal Awardee Performance and Integrity Information System 
(FAPIIS)
    The IHS is required to review and consider any information about 
the applicant that is in the FAPIIS at https://www.fapiis.gov/fapiis/#/home before making any award in excess of the simplified acquisition 
threshold (currently $250,000) over the period of performance. An 
applicant may review and comment on any information about itself that a 
Federal awarding agency previously entered. The IHS will consider any 
comments by the applicant, in addition to other information in FAPIIS, 
in making a judgment about the applicant's integrity, business ethics, 
and record of performance under Federal awards when completing the 
review of risk posed by applicants, as described in 45 CFR 75.205.
    As required by 45 CFR part 75, appendix XII of the Uniform 
Guidance, NFEs are required to disclose in FAPIIS any information about 
criminal, civil, and administrative proceedings, and/or affirm that 
there is no new information to provide. This applies to NFEs that 
receive Federal awards (currently active grants, cooperative 
agreements, and procurement contracts) greater than $10 million for any 
period of time during the period of performance of an award/project.
Mandatory Disclosure Requirements
    As required by 2 CFR part 200 of the Uniform Guidance, and the HHS 
implementing regulations at 45 CFR part 75, the IHS must require an NFE 
or an applicant for a Federal award to disclose, in a timely manner, in 
writing to the IHS or pass-through entity all violations of Federal 
criminal law involving fraud, bribery, or gratuity violations 
potentially affecting the Federal award.
    All applicants and awardees must disclose in writing, in a timely 
manner, to the IHS and to the HHS Office of Inspector General all 
information related to violations of Federal criminal law involving 
fraud, bribery, or gratuity violations potentially affecting the 
Federal award. 45 CFR 75.113.
    Disclosures must be sent in writing to: U.S. Department of Health 
and Human Services, Indian Health Service, Division of Grants 
Management, ATTN: Marsha Brookins, Director, 5600 Fishers Lane, Mail 
Stop: 09E47, Rockville, MD 20857. (Include ``Mandatory Grant 
Disclosures'' in subject line). Office: (301) 443-4750. Fax: (301) 594-
0899. Email: [email protected].
AND
    U.S. Department of Health and Human Services, Office of Inspector 
General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 
Independence Avenue SW, Cohen Building, Room 5527, Washington, DC 
20201. URL: https://oig.hhs.gov/fraud/report-fraud/. (Include 
``Mandatory Grant Disclosures'' in subject line). Fax: (202) 205-0604 
(Include ``Mandatory Grant Disclosures'' in subject line) or Email: 
[email protected].
    Failure to make required disclosures can result in any of the 
remedies described in 45 CFR 75.371 Remedies for noncompliance, 
including suspension or debarment (see 2 CFR part 180 and 2 CFR part 
376).

VII. Agency Contacts

    1. Questions on the programmatic issues may be directed to: JB 
Kinlacheeny, Public Health Advisor, Indian Health Service, Division of 
Behavioral Health, 5600 Fishers Lane, Mail Stop: 0834NB, Rockville, MD 
20857. Phone: (301) 443-0104. Email: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Indian Health Service, Division of Grants Management, 5600 
Fishers Lane, Mail Stop: 09E47, Rockville, MD 20857, Email: 
[email protected]. For technical assistance with Grants.gov, please contact 
the Grants.gov help desk at 800-518-4726, or by email at 
[email protected].

VIII. Other Information

    The Public Health Service strongly encourages all grant, 
cooperative agreement, and contract awardees to provide a smoke-free 
workplace and promote the non-use of all tobacco products. In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities

[[Page 12964]]

(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.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-04151 Filed 2-28-23; 8:45 am]
BILLING CODE 4165-16-P