Addressing Dementia in Indian Country: Models of Care, 18558-18567 [2023-06455]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 88, Number 60 (Wednesday, March 29, 2023)]
[Notices]
[Pages 18558-18567]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-06455]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Addressing Dementia in Indian Country: Models of Care

    Announcement Type: New.
    Funding Announcement Number: HHS-2023-IHS-ALZ-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.933.

Key Dates

    Application Deadline Date: June 27, 2023.
    Earliest Anticipated Start Date: August 11, 2023.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for 
cooperative agreements for Addressing Dementia in Indian Country. This 
program is authorized under the Snyder Act, 25 U.S.C. 13; the Transfer 
Act, 42 U.S.C. 2001(a); and the Indian Health Care Improvement Act, 25 
U.S.C. 1665a(c)(5)(F) and 1660e. This program is described in the 
Assistance Listings located at https://sam.gov/content/home (formerly 
known as the CFDA) under 93.933.

Background

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

[[Page 18559]]

Dementia, alcohol-related dementia, dementia related to traumatic brain 
injury, and mixed dementia (attributable to more than one cause of 
cognitive impairment). Age is the most significant risk factor for 
Alzheimer's disease. Although the average age of the American Indian 
and Alaska Native (AI/AN) population is younger than the United States 
(U.S.) average population as a whole, the AI/AN group ages 65 and older 
is growing more rapidly than the U.S. population. The Centers for 
Disease Control and Prevention (CDC) notes that the number of AI/AN 
aged 65 and older is expected to triple in the next 30 years, with the 
oldest--those 85 years and older--increasing even more rapidly. While 
age is the most substantial risk factor for Alzheimer's disease, early-
onset occurs in younger populations and in persons with Down Syndrome 
or Trisomy 21, who are at markedly increased risk for Alzheimer's 
Disease. Conditions such as diabetes, cardiovascular disease, chronic 
kidney disease, chronic liver disease, and traumatic brain injury 
increase the risk of dementia and can lead to a more rapid worsening.
    Dementia of all types is under-recognized, underdiagnosed, and 
undertreated in all populations in the U.S., and anecdotal evidence 
suggests this is very much true for the AI/AN population. Many 
individuals go unrecognized in the community, never seeking care and 
living with impaired cognition that puts them at risk for financial 
exploitation, poor health outcomes, and accidental injury. Individuals 
and their families may not recognize the cognitive changes that 
dementia brings. They may think the changes are due to normal aging or 
may accept the changes and not seek care out of concern for the elder's 
dignity. Failure to recognize dementia may also stem from the stigma 
associated with dementia and from a lack of awareness of the resources 
available. Often it takes a crisis or illness to bring attention to the 
condition. Diagnosis of dementia is most often made in the primary care 
office or clinic, with specialty referral needed when the presentation 
is not typical or apparent. But primary care providers may lack the 
confidence or knowledge to make the diagnosis or plan effective care. 
They also may not have access to an interdisciplinary team to support 
care or specialists through consultation or referral to support 
diagnosis and management decisions. Effective management of dementia 
crosses many boundaries, involving medical care, personal care, social 
services, legal and financial services, and housing. Management of 
dementia requires coordination between clinical services and community-
based services. Those living with dementia and their caregivers are too 
often left to coordinate this complex care themselves. Most persons 
living with dementia receive some care and assistance from caregivers 
and sometimes from family members. Care for the person living with 
dementia should include consideration for their caregivers; 
unfortunately, this is not common.
    Effective models for addressing dementia in Tribal and Urban Indian 
communities will be supported by evidence and will emerge through 
development or adaptation and evaluation from those communities. A 
recent report by the Agency for Healthcare Research and Quality and the 
National Academies of Science, Engineering, and Medicine points to the 
Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) 
caregiver support intervention and models of coordinated care as 
interventions that have evidence for benefit and are ready for 
implementation and further evaluation.\1\ The REACH into Indian Country 
initiative successfully trained public and community health nurses to 
provide the REACH intervention in Tribal communities. Communities 
across the country, including some Tribal communities, use the 
Dementia-Friendly Communities approach to building community-based 
efforts to improve care for persons living with dementia and their 
families.\2\ A large number of evidence-based programs have been 
cataloged online.\3\ The Alzheimer's and Dementia Care Program is one 
example of an evidence-based program that works with primary care 
providers to provide comprehensive and coordinated care to persons 
living with dementia and their caregivers.\4\ The Healthy Brain 
Initiative Roadmap for Indian Country, developed by the CDC and the 
Alzheimer's Association, is designed to support discussion about 
dementia and caregiving with Tribal communities and encourage a public 
health approach as part of a larger holistic response.\5\ These and 
other models and resources can help inform the design of Tribal and 
Urban Indian health models.
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    \1\ National Academies of Sciences, Engineering, and Medicine. 
2021. Meeting the challenge of caring for persons living with 
dementia and their care partners and caregivers: A way forward. 
Washington, DC: The National Academies Press. https://doi.org/10.17226/26026.
    \2\ Dementia Friendly America https://www.dfamerica.org https://iasquared.org/news-release-ia2-is-now-a-national-dementia-friends-sub-licensee-for-american-indian-and-alaska-native-tribal-communities/.
    \3\ Best Practice Caregiving online database. https://bpc.caregiver.org/#searchPrograms.
    \4\ The Alzheimer's and Dementia Care Program. https://www.adcprogram.org/.
    \5\ Centers for Disease Control and Prevention. Road Map for 
Indian Country. https://www.cdc.gov/aging/healthybrain/indian-country-roadmap.html.
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Purpose

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

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needs and support caregivers. Those living with dementia and their 
caregivers often need support and assistance navigating the various 
systems providing this care.
    e. Support for Caregivers. Care for persons living with dementia 
includes care for their caregivers. Families and other caregivers need 
help navigating services and mobilizing respite care, help in 
understanding what to expect and how to respond to the challenges of 
living with dementia, and support for self-care. Interventions that 
provide that care and support (e.g., REACH) and provide education and 
training (e.g., Savvy Caregiver) have been adapted for use in Tribal 
communities.
    2. Develop, in collaboration with the IHS Alzheimer's Grant 
Program, best and promising practices to include tools, resources, 
reports, and presentations accessible to Federal, Tribal, and Urban 
Indian health programs as they plan and implement their own programs.
    3. Identify and implement reimbursement and funding streams that 
will support service delivery and facilitate sustainability. 
Opportunities for reimbursement and funding streams are dependent on 
the specific interventions planned, but potential sources might 
include:
    a. Medicare reimbursement through the Physician Fee Schedule, 
including Cognitive Assessment and Planning codes and Chronic and 
Complex Care Management codes.
    b. Medicaid and other state programs.
    c. Purchased and Referred Care resources.
    d. IHS and Third Party Revenue.
    The IHS Alzheimer's Grant Program in the IHS Division of Clinical 
and Community Services (DCCS) will provide technical assistance to 
grantees in the development of a plan for sustainability.

Required, Optional, and Allowable Activities

    Awardees must plan to participate in regular (not more than 
monthly) web-based opportunities to share their experience and 
expertise with other awardees and to participate in at least one 
annual, one to two day in-person meeting in a location to be 
determined. In addition, optional training and technical assistance 
opportunities will be provided.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2023 is 
approximately $1.2 million. Individual award amounts for the first 
budget year are anticipated to be between $100,000 and $200,000. The 
funding available for competing and subsequent continuation awards 
issued under this announcement is subject to the availability of 
appropriations and budgetary priorities of the Agency. The IHS is under 
no obligation to make awards that are selected for funding under this 
announcement.
Anticipated Number of Awards
    Approximately six awards will be issued under this program 
announcement.
Period of Performance
    The period of performance is for 2 years.
Cooperative Agreement
    Cooperative agreements awarded by the Department of Health and 
Human Services (HHS) are administered under the same policies as 
grants. However, the funding agency, IHS, is anticipated to have 
substantial programmatic involvement in the project during the entire 
period of performance. Below is a detailed description of the level of 
involvement required of the IHS.
Substantial Agency Involvement Description for Cooperative Agreement
    1. The IHS DCCS Alzheimer's Grant Program, will collaborate with 
recipients throughout the process of project planning and 
implementation and assist in the identification of tools, resources, 
reports, and presentations for dissemination to other Tribal, IHS, and 
Urban Indian health programs. The IHS will also provide technical 
assistance in evaluation plan implementation and developing a 
sustainability plan, as needed.
    2. The IHS will convene recipients periodically, not more often 
than monthly, to share ideas, strategies, and tools to accelerate 
design and implementation progress.
    3. The IHS will link recipients with Federal agencies and non-
governmental organizations working to improve the care of persons 
living with dementia and their caregivers.
    4. The IHS will coordinate reporting (e.g., identified metrics 
utilized, achieved goals, identified best practices, etc.) and 
technical assistance (e.g., programmatic support to Tribal communities) 
as required.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity, an applicant cannot be 
an existing awardee under the Addressing Dementia in Indian Country 
program. Also, under this announcement, an applicant must be one of the 
following as defined under 25 U.S.C. 1603:
     A federally recognized Indian Tribe as defined by 25 
U.S.C. 1603(14). The term ``Indian Tribe'' means any Indian Tribe, 
band, nation, or other organized group or community, including any 
Alaska Native village or group, or regional or village corporation, as 
defined in or established pursuant to the Alaska Native Claims 
Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is 
recognized as eligible for the special programs and services provided 
by the U.S. to Indians because of their status as Indians.
     A Tribal organization as defined by 25 U.S.C. 1603(26). 
The term ``Tribal organization'' has the meaning given the term in 
Section 4 of the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 5304(l)): ``Tribal organization'' means the recognized 
governing body of any Indian Tribe; any legally established 
organization of Indians which is controlled, sanctioned, or chartered 
by such governing body or which is democratically elected by the adult 
members of the Indian community to be served by such organization and 
which includes the maximum participation of Indians in all phases of 
its activities: provided that, in any case where a contract is let or 
grant made to an organization to perform services benefiting more than 
one Indian Tribe, the approval of each such Indian Tribe shall be a 
prerequisite to the letting or making of such contract or grant. 
Applicant shall submit letters of support and/or Tribal Resolutions 
from the Tribes to be served.
     An Urban Indian organization, as defined by 25 U.S.C. 
1603(29). The term ``Urban Indian organization'' means a nonprofit 
corporate body situated in an urban center, governed by an Urban Indian 
controlled board of directors, and providing for the maximum 
participation of all interested Indian groups and individuals, which 
body is capable of legally cooperating with other public and private 
entities for the purpose of performing the activities described in 25 
U.S.C. 1653(a). Applicants must provide proof of

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nonprofit status with the application, e.g., 501(c)(3).
    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. The DGM will notify the applicant.
Additional Required Documentation
Tribal Resolution
    The DGM must receive an official, signed Tribal Resolution prior to 
issuing a Notice of Award (NoA) to any Tribe or Tribal organization 
selected for funding. An applicant that is proposing a project 
affecting another Indian Tribe must include Tribal Resolutions from all 
affected Tribes to be served. However, if an official signed Tribal 
Resolution cannot be submitted with the application prior to the 
application deadline date, a draft Tribal Resolution must be submitted 
with the application by the deadline date in order for the application 
to be considered complete and eligible for review. The draft Tribal 
Resolution is not in lieu of the required signed resolution but is 
acceptable until a signed resolution is received. If an application 
without a signed Tribal Resolution is selected for funding, the 
applicant will be contacted by the Grants Management Specialist (GMS) 
listed in this funding announcement and given 90 days to submit an 
official signed Tribal Resolution to the GMS. If the signed Tribal 
Resolution is not received within 90 days, the award will be forfeited.
    Applicants organized with a governing structure other than a Tribal 
council may submit an equivalent document commensurate with their 
governing organization.
Proof of Nonprofit Status
    Organizations claiming nonprofit status must submit a current copy 
of the 501(c)(3) Certificate with the application.

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 (one page).
     Project Narrative (not to exceed 10 pages). See Section 
IV.2.A, Project Narrative for instructions.
     Budget Narrative (not to exceed five pages). See Section 
IV.2.B, Budget Narrative for instructions.
     Work plan chart.
     Tribal Resolution(s) as described in Section III, 
Eligibility, if applicable.
     Letters of Support from organization's Board of Directors 
(optional).
     501(c)(3) Certificate, if applicable.
     Biographical sketches for all Key Personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Organizational Chart.
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    1. Email confirmation from Federal Audit Clearinghouse (FAC) that 
audits were submitted; or
    2. Face sheets from audit reports. Applicants can find these on the 
FAC website at https://facdissem.census.gov/.
Public Policy Requirements
    All Federal public policies apply to IHS grants and cooperative 
agreements. Pursuant to 45 CFR 80.3(d), an individual shall not be 
deemed subjected to discrimination by reason of their exclusion from 
benefits limited by Federal law to individuals eligible for benefits 
and services from the IHS. See https://www.hhs.gov/grants/grants/grants-policies-regulations/.
Requirements for Project and Budget Narratives
A. Project Narrative
    This narrative should be a separate document that is no more than 
10 pages and must: (1) have consecutively numbered pages; (2) use black 
font 12 points or larger (applicants may use 10 point font for tables); 
(3) be single-spaced; and (4) be formatted to fit standard letter paper 
(8-1/2 x 11 inches). 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 section 
noted below or they will not be considered or scored. If the narrative 
exceeds the overall page limit, the reviewers will be directed to 
ignore any content beyond the page limit. The 10-page limit for the 
project narrative does not include the accompanying work plan, standard 
forms, Tribal Resolutions, 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.

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Part 1: Program Information (Limit--4 Pages)
Section 1: Tribal or Organizational Overview
    Provide a brief description of the Tribe, Tribal organization, or 
Urban Indian health program, health care delivery system and resources, 
elderly services and resources, long-term services and supports, and 
other Tribal or community-based services that might be involved.
Section 2: Needs
    Provide any data available about the number of persons living with 
dementia, their needs, and the needs of their caregivers. If data is 
not currently available, indicate this here and in Part 2 below, and 
describe in detail how the applicant will obtain or develop this data 
in the first year of the program.
Section 3: Other Funded Initiatives
    Provide information about other funded initiatives addressing 
dementia that the applicant is or will be participating in that are 
relevant to this proposal. Indicate any HHS grants addressing dementia 
(e.g., Dementia Capability in Indian Country Grant program of the 
Administration for Community Living) the applicant has been awarded 
whose period of performance may overlap the period of performance of 
this grant opportunity.
Part 2: Program Planning and Evaluation (Limit--4 Pages)
Section 1: Program Plans
    Describe fully and clearly the applicant's plan to implement a 
comprehensive approach to care and services for persons living with 
dementia and their caregivers and identify funding streams that will 
support service delivery. State the purpose, goals, and objectives of 
your proposed project. The plan should include a vision for a 
comprehensive approach to care, recognizing that achieving the fully 
implemented approach may not be feasible within the period of 
performance.
Section 2: Program Evaluation
    Describe fully and clearly the methods, data sources, and measures 
that will be used to monitor the progress of the proposed activities 
and determine effectiveness in implementing the plan and progress 
towards achieving goals as described in Section 1. The evaluation plan 
should include the specific measures, e.g., outputs and outcomes that 
will be used to assess achievement. The evaluation plan should, at a 
minimum, include performance measures about the number of persons newly 
diagnosed with dementia, the number of persons living with a pre-
existing dementia diagnosis, screening measures, and case finding 
efforts among their patient population. If the applicant intends to 
obtain or develop data about the needs of persons living with dementia 
and the needs of their caregivers as an element of this award, the 
applicant should indicate those data elements and describe how that 
data will be developed or acquired in the first year.
Part 3: Program Report (Limit--2 Pages)
Section 1
    Identify and describe your organization's significant program 
activities and accomplishments within the past five years associated 
with developing and implementing clinical or community care and support 
services for people living with dementia and their caregivers, if any. 
Provide a comparison of actual accomplishments to the established 
goals, where relevant. If applicable, provide justification for the 
lack of or limited progress.
Section 2: Sharing With Other Tribes, Tribal Organizations, and Urban 
Indian Organizations
    Describe how your program will develop and share, in collaboration 
with the IHS, best and promising practices that include tools, 
resources, reports, and presentations accessible to stakeholders across 
the Tribal health system including Tribal and Urban Indian health 
partners.
B. Budget Narrative (Limit--5 Pages)
    Provide a budget narrative table 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 would 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 ([email protected]), Deputy Director, DGM, by telephone at 
(301) 443-2114. 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 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 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]. 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. Applications 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.

[[Page 18563]]

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
    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 two to five 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

A. Introduction and Need for Assistance (10 Points)
    1. Description of the clinical services, elder services and 
resources, long-term care services, and supports available through the 
applicant's organization, either as a direct service or through 
agreement, contract, or Purchased and Referred Care (PRC). Applicants 
must be able to provide ambulatory care services directly or through 
coordination with IHS Direct Services and must be able to coordinate 
with elder services.
    2. Description of the number of individuals living with dementia to 
be served, any data available about the prevalence of risk factors for 
dementia (including age as reflected in the population's demographics), 
and any limitations of the data available.
    3. Identification of the most urgent and pressing gaps in 
availability or quality of care and services for persons living with 
dementia and their families. If this information is not available, the 
acquisition of this information should be a detailed part of the 
Project Objective(s), Work Plan, and Approach.
    4. If the applicant is the recipient of other HHS grants that will 
provide funding to address dementia over the same time period (e.g., 
Dementia Capability in Indian Country Grant program of the 
Administration for Community Living), address how funding under this 
opportunity will address the need without overlapping the activities of 
other funded awards, if applicable.
B. Project Objective(s), Work Plan, and Approach (30 Points)
    1. The overall vision for a comprehensive approach to care and 
services for persons living with dementia and their caregivers, 
including:
     Awareness and recognition.
     Timely and accurate diagnosis.
     Multidisciplinary assessment.
     Management and referral.
     Caregiver Support.
    2. The elements of this vision that the awardee anticipates 
implementing, including planning activities and assessment of need, if 
not already available.
    3. Describe the approach to accomplishing the work plan, including 
planning activities and assessment of need, if not already available. 
This work plan should be responsive to the most urgent and pressing 
gaps in availability and quality of care and services for persons 
living with dementia and their families. This work plan must include, 
at minimum, both the provision of clinical services, either directly or 
through coordination with IHS Direct Services, and the engagement of 
elder services.
    4. The accompanying work plan and approach should include 
developing

[[Page 18564]]

tools, resources, reports, and presentations to support the development 
of programs by other Tribes, Tribal organizations, or Urban Indian 
health programs.
    5. If the applicant is the recipient of other HHS grants that will 
provide funding to address dementia over the same time period (e.g. 
Dementia Capability in Indian Country Grant program of the 
Administration for Community Living), indicate how the work plan and 
approach supported through this funding will complement and not 
supplant or overlap that already-funded work.
C. Program Evaluation (30 Points)
    1. Clearly identify a goal or goals and plans for program 
evaluation to ensure that the objectives of the program are met at the 
conclusion of the period of performance.
    2. Include SMART (Specific, Measurable, Achievable, Relevant and 
Time-based) objectives to establish a specific set of evaluation 
criteria to ensure the goals are attainable within the period of 
performance.
    3. Evaluation should include metrics that provide insight into the 
implementation of those elements of a comprehensive approach to care 
and services for persons living with dementia and their families that 
the applicant has proposed to implement. The evaluation plan should 
include metrics about the number of persons newly diagnosed, persons 
living with a pre-existing dementia diagnosis, screening measures, and 
case finding efforts among their patient population. The evaluation 
should also include metrics for important outcomes of care for persons 
living with dementia and their family or caregiver(s), such as 
avoidance of crisis-driven care (e.g., emergent transfers and undesired 
out-of-home placement) and processes of care that contribute to better 
outcomes (e.g., reduction of medications that impair cognition). If the 
applicant intends to obtain or develop new data collection methods or 
metrics as an element of this award, the applicant should describe how 
that data will be developed or acquired in the first year. Please refer 
to the draft logic model example in the appendix as a guide.
D. Organizational Capabilities, Key Personnel, and Qualifications (20 
Points)
    1. Include an organizational capacity statement that demonstrates 
the ability to execute program strategies within the period of 
performance.
    2. Project management and staffing plan. Detail that the 
organization has the current staffing and expertise to address each of 
the program activities. If capacity does not exist, please describe the 
applicant's actions to fill this gap within a specified timeline.
    3. Identify any partnerships or collaborations that will be needed 
to implement the work plan and include letters of support or intent to 
coordinate or collaborate with those partners.
    4. Demonstrate that the applicant has previous successful 
experience providing technical or programmatic support to Tribal 
communities.
E. Categorical Budget and Budget Justification (10 Points)
    Provide a detailed budget and accompanying narrative to explain the 
activities being considered and how they are related to proposed 
program objectives.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     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 the 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 DGM 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 DCCS within 30 days of the conclusion of the ORC outlining the 
strengths and weaknesses of their application. The summary statement 
will be sent to the Authorizing Official identified on the face page 
(SF-424) of the application.
A. Award Notices for Funded Applications
    The NoA is the authorizing document for which funds are dispersed 
to the approved entities and reflects the amount of Federal funds 
awarded, the purpose of the award, the terms and conditions of the 
award, the effective date of the award, the budget period, and period 
of performance. 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 one 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:
     HHS Grants Policy Statement, Revised January 2007, at 
https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.

[[Page 18565]]

    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 part 
200.216. This will also be described in the terms and conditions of 
every IHS grant and cooperative agreement awarded on or after August 
13, 2020.

2. Indirect Costs

    This section applies to all 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 GMS 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 
award, 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 quarterly. The progress 
reports are due within 90 days after the reporting period ends 
(specific dates will be listed in the NoA Terms and Conditions). A 
progress report template will be provided. 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 120 
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
    The grantee will participate in periodic (not more frequently than 
monthly) web-based calls with the program office or designee and the 
other recipients to share their progress, experience, and tools and 
resource that might be useful for other recipients. The grantee will be 
expected to work with the program office to develop a driver diagram 
(an action-oriented logic model) that describes the comprehensive 
approach to care and services for persons living with dementia and 
their caregivers and identifies key performance metrics based on their 
evaluation plan.
    The grantee will be expected to share, on a quarterly basis, the 
tools, resources, reports, and presentations produced that may support 
the development of programs by other Tribes, Tribal organizations, or 
Urban Indian health programs.
D. Federal Sub-Award Reporting System (FSRS)
    This award may be subject to the Transparency Act sub-award and 
executive compensation reporting requirements of 2 CFR part 170.
    The Transparency Act requires the OMB to establish a single 
searchable database, accessible to the public, with information on 
financial assistance awards made by Federal agencies. The Transparency 
Act also includes a requirement for 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

[[Page 18566]]

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 (FFA)
    The awardee must administer the project in compliance with Federal 
civil rights laws, where applicable, 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/.
     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.
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: 09E70, 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 program matters may be directed to: Dr. Jolie 
Crowder, National Elder Services Consultant, Office of Clinical and 
Preventive Services, Division of Clinical and Community Services, 
Indian Health Service, 5600 Fishers Lane, Mailstop: 08N34-A, Rockville, 
MD 20857, Phone: (301) 526-6592, Fax: (301) 594-6213, Email: 
[email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Donald Gooding, Grants Management Specialist, Indian 
Health Service, Division of Grants Management, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, MD 20857, Phone: (301) 443-2298, Email: 
[email protected].
    3. 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 (or in some cases, any portion of the facility) in 
which regular or routine education, library, day care, health care,

[[Page 18567]]

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. 2023-06455 Filed 3-28-23; 8:45 am]
BILLING CODE P