Produce Prescription Pilot Program, 24812-24821 [2023-08614]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 88, Number 78 (Monday, April 24, 2023)]
[Notices]
[Pages 24812-24821]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-08614]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Produce Prescription Pilot Program

    Announcement Type: New.
    Funding Announcement Number: HHS-2023-IHS-PPPP-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.933.
Key Dates
    Application Deadline Date: June 8, 2023.
    Earliest Anticipated Start Date: June 23, 2023.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for a 
cooperative agreement for the Produce Prescription Pilot Program (P4). 
This program is authorized under the Snyder Act, 25 U.S.C. 13; the 
Transfer Act, 42 U.S.C. 2001(a); and the Consolidated Appropriations 
Act, 2022, Public Law 117-103, 136 Stat. 49, 398 (2022). The Assistance 
Listings section of SAM.gov (https://sam.gov/content/home) describes 
this program under 93.933.

Background

    Social determinants of health (SDOH) are the conditions in the 
environments where individuals are born, live, learn, work, play, 
worship, and age, that affect health and quality of life risks and 
outcomes. One of the SDOH that can contribute significantly to various 
health disparities and inequities is access to nutritious foods. If 
people or communities do not have nutrition

[[Page 24813]]

security, they are less likely to have good nutrition, placing them at 
risk for health problems, such as heart disease, diabetes, and obesity 
(https://health.gov/healthypeople/priority-areas/social-determinants-health). Studies have shown that people and communities of color, 
families with children, and people who live in remote areas, including 
Tribal communities, have a higher rate of diet-related chronic diseases 
(https://www.usda.gov/media/press-releases/2022/03/17/usda-announces-actions-nutrition-security). For example, according to the 2022 Centers 
for Disease Control National Diabetes Statistics Report, the prevalence 
of diagnosed diabetes was highest among American Indians and Alaska 
Natives (14.5 percent), followed by non-Hispanic Blacks (12.1 percent), 
people of Hispanic origin (11.8 percent), non-Hispanic Asians (9.5 
percent) and non-Hispanic Whites (7.4 percent), compared to 8.7 percent 
of the United States (U.S.) population (https://www.cdc.gov/diabetes/data/statistics-report/).
    The food security survey conducted in 2021 by the U.S. Department 
of Agriculture (USDA) found 10.2 percent (13.5 million) of U.S. 
households were food insecure (https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=8250.2). American Indian and Alaskan 
Native (AI/AN) people are at a greater risk for food insecurity than 
White Americans, Black Americans, or Hispanic Americans. About one in 
four AI/AN people experience food insecurity, compared to 1 in 9 
Americans overall, and 1 in 12 White/non-Hispanic individuals. The 
higher rates of food insecurity among AI/AN people have been attributed 
to limited income, employment, and resources, such as lack of access to 
full-service grocery stores or living in food deserts (https://
moveforhunger.org/native-americans-food-
insecure#:~:text=About%20one%20in%20four%20Native,access%20to%20sufficie
nt%2C%20affordable%20food). Other SDOH in Tribal communities, such as 
education, transportation, income etc., contribute to food insecurity. 
This forces many AI/AN people to choose cheaper foods that have a long 
shelf life instead of buying fresh foods, which are more expensive and 
harder to access. To help address food insecurity, many AI/AN 
communities utilize federally funded food programs, such as the 
Supplemental Nutrition Assistance Program (SNAP) and the USDA Food 
Distribution Program on Indian Reservations (FDPIR). Despite these 
assistance programs, AI/AN communities continue to struggle with high 
rates of food insecurity and diet-related chronic diseases.
    According to the National Produce Prescription Collaborative 
(2021), Produce Prescription Programs have been shown to increase 
access to nutritious foods in communities at risk for food insecurity 
(https://www.nppc.health/). Produce Prescription Programs help 
individuals/families who are experiencing food insecurity and/or diet-
related health problems more easily obtain fresh fruits and vegetables 
by obtaining a prescription from a health care provider. Individuals/
families obtain a prescription from their health care provider for 
fresh fruits and vegetables that is filled by food retailers with 
produce. When appropriately implemented, Produce Prescription Programs 
improve health care outcomes, optimize medical spending, and increase 
patient engagement and satisfaction.
    Congress has authorized funding for the IHS to create a Produce 
Prescription Pilot Program (P4) to increase access to produce and 
traditional foods within AI/AN communities. This pilot program is part 
of the IHS's efforts to implement the Administration's National 
Strategy on Hunger, Nutrition, and Health (https://www.whitehouse.gov/wp-content/uploads/2022/09/White-House-National-Strategy-on-Hunger-Nutrition-and-Health-FINAL.pdf), which aims to end hunger and increase 
healthy eating and physical activity by 2030 so fewer Americans 
experience diet-related diseases, while also reducing disparities (such 
as those seen in AI/AN communities). The program provides an 
opportunity to engage Tribal communities in addressing food insecurity 
and decreasing the risk for diet-related illness. By including 
traditional foods, it also provides an opportunity to deliver 
culturally appropriate nutrition education.

Purpose

    The purpose of this program is to help establish Produce 
Prescription Programs through collaborations with stakeholders from 
various health care and food industries in Tribal communities. The P4 
will help increase access to fruits, vegetables, and healthy 
traditional foods for AI/AN people by allowing eligible individuals to 
receive a fruit and vegetable voucher from a participating health care 
provider to redeem at a local market. The goal of this pilot is to 
demonstrate and evaluate the impact of Produce Prescription Programs on 
AI/AN people and their families, specifically by:
    1. Reducing food insecurity;
    2. Improving overall dietary health by increasing fruits, 
vegetables, and traditional food consumption; and
    3. Improving health care outcomes.

Required Activities

    (1) All recipients must implement a P4 in their communities, by:
    (a) Developing the infrastructure to implement and maintain a 
Produce Prescription Program that fosters ongoing collaboration with 
one or more Tribal, Federal, or urban health care facilities and local 
markets/organizations/services that provide fresh fruits and vegetables 
and/or traditional foods (stores, markets, farmers, mobile unit, etc.);
    (b) Identifying an eligible AI/AN population or Urban Indian 
Organization (e.g., people with diabetes or individuals with Body Mass 
Index (BMI)>30) that can be significantly impacted. Indicating how many 
eligible individuals and their families can be served with the current 
budget and services available.
    (i) Using the U.S. Adult Food Security Survey Module (https://www.ers.usda.gov/media/8279/ad2012.pdf) to identify eligible 
participants to be enrolled in this program. Participants must be food 
insecure at baseline to participate, as defined by the U.S. Adult Food 
Security Survey Module.
    (c) Implementing a nutrition education program that teaches program 
participants about proper nutrition and the impact it has on disease 
risk reduction and overall health. A nutrition education program should 
include information on cultivation and preparation for consumption of 
traditional foods; and
    (d) Developing an evaluation plan that tracks and trends data to 
demonstrate the impact P4 has on the community. Data must show:
    (i) Measurement of food insecurity over time using the U.S. Adult 
Food Security Survey Module (https://www.ers.usda.gov/media/8279/ad2012.pdf). Did food insecurity rates decrease, increase, or remain 
unchanged by participating in P4?
    (ii) Participant's use of services offered by the program. How is 
the implementation of P4 measured? What percentage of participants 
redeem the produce vouchers? How is consumption of produce measured and 
what percentage of participants consume the produce? How much fruit and 
vegetables are consumed at baseline and how did that amount change over 
time,

[[Page 24814]]

in comparison to the number of vouchers prescribed by the health care 
provider? Did the participants attend the education program?
    (iii) Evidence of improvement in health outcomes. Are healthcare 
facility records available and accessible, in accordance with privacy 
laws, to track changes in participant's clinical parameters such as A1C 
and lipid levels? Are anthropometric measures also available through 
the healthcare facility or measured in separate facilities and made 
available for analysis?
    (iv) Changes in access to healthy and traditional foods.
    (2) Recipients must:
    (a) Consult with and accept guidance from the IHS Division of 
Diabetes Treatment and Prevention (DDTP), the IHS Division of Grants 
Management (DGM), and their Federal Program Officer(s) and/or 
designated assignee(s);
    (b) Attend quarterly conference calls established by DDTP, and 
provide update on the progress of P4 implementation;
    (c) Respond promptly to requests for information;
    (d) Provide short presentations on their processes and successes, 
as requested;
    (e) Keep DDTP informed of emerging issues, developments, and 
challenges that may affect the recipient's ability to comply with the 
award Terms and Conditions and/or any requirements;
    (f) Have an officially approved Project Director (approved by the 
Grants Management Officer in consultation with the Program Official) to 
plan/initiate and maintain the P4, who has the following 
qualifications:
    (i) Relevant health or wellness education and/or experience;
    (ii) Experience with award program management, including skills in 
program coordination, budgeting, reporting, and staff supervision; and
    (iii) Working knowledge of nutrition and nutrition challenges in 
AI/AN communities.
    (g) Complete and submit an annual progress report to the IHS by 
attaching it as a Grant Note in GrantSolutions. Instructions, 
template(s), and other information will be provided;
    (h) Submit baseline, semi-annual, and annual/final data to the IHS; 
and
    (i) Participate in trainings provided by DDTP.

II. Award Information

Funding Instrument--Cooperative Agreement

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2023 is 
approximately $2.5 million. This $2.5 million will be divided into 
individual award amounts. Each of these award amounts are anticipated 
to be less than $500,000 per year (applications requesting more than 
$500,000 will be rejected). The applicant, based on capacity, need, 
size of target AI/AN population, and proposed program, will request an 
individual award amount of $500,000 or less. For example, smaller 
programs will request less funding than their larger counterparts. 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. Selections will be made based on community needs, 
objectives, and outcomes that align with the goals of this pilot 
program.
Anticipated Number of Awards
    The IHS anticipates issuing approximately six to eight awards 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 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) Identify a core group of IHS staff to work with the recipient 
in providing technical assistance and guidance.
    (2) Regularly meet with the recipient to review P4 work plan and 
provide guidance and feedback on implementation, program evaluation, 
and data collection strategy and tools.
    (3) Establish and convene quarterly conference calls to provide P4 
updates and discuss recipient progress.
    (4) Work with the recipient to display the results of this project 
by publishing on shared websites as well as in jointly authored 
publications.
    (5) Use the evidence-based program(s), framework(s), and data 
collection requirement(s) to develop an evaluation plan to collect 
national program aggregate and local evidence-based practice fidelity 
data.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity, 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 United States 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 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. Applicants 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 nonprofit status with 
the application, e.g., 501(c)(3).
    The DGM will notify any applicants deemed ineligible.

[[Page 24815]]

2. Additional Information on Eligibility

    The IHS does not fund concurrent projects. If an applicant is 
successful under this announcement, any subsequent applications in 
response to other P4 announcements from the same applicant will not be 
funded. Applications on behalf of individuals (including sole 
proprietorships) and foreign organizations are not eligible and will be 
disqualified from competitive review and funding under this funding 
opportunity.

    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.

3. Cost Sharing or Matching

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

4. Other Requirements

    Applications with budget requests that exceed $500,000 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.
    The following documentation is required (if applicable):
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 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 merit review and in 
processing awards. Upload all requested and optional documents 
individually, rather than combining them into a package. Creating a 
package 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 merit 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:
    a. 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.
    b. Project Narrative (not to exceed 25 pages). See Section IV.2.A, 
Project Narrative for instructions.
    c. Budget Justification/Narrative (not to exceed 5 pages). See 
Section IV.2.B, Budget Narrative for instructions.
    d. Tribal Resolution(s) as described in Section III, Eligibility.
    e. 501(c)(3) Certificate, if applicable.
    f. Biographical sketches for all Key Personnel.
    g. Contractor/Consultant resumes or qualifications and scope of 
work.
    h. Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
    i. Certification Regarding Lobbying (GG-Lobbying Form).
    j. Copy of current Negotiated Indirect Cost (IDC) rate agreement 
(required in order to receive IDC).
    k. 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 
25 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 25-page limit for the 
project narrative does not include 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 four parts to the project narrative: Part 1--Needs 
Assessment; Part 2--Program Description/Operational Plan; Part 3--
Evaluation; and Part 4--Organizational Capabilities. See below for 
details about what to include in each section, and suggested page 
limits for each section.
Part 1: Needs Assessment (Limit--5 Pages)
    Provide a description of the need for a Produce Prescription 
Program for the

[[Page 24816]]

community to be served. Applicant should describe the:
    (1) Profile of community socioeconomic and demographic 
characteristics;
    (2) Profile of community diet-related health status and diseases, 
if available. For example, is there a higher rate of diabetes, obesity, 
cardiac disease, etc. in the community, due potentially to the lack of 
access to nutritious food;
    (3) Profile of community food resources;
    (4) Assessment of food resource accessibility; and
    (5) Assessment of food availability, affordability, and insecurity.
Part 2: Program Description/Operational Plan (Limit--10 Pages)
    Applicant should describe:
    (1) The health care facility being used for this program (can be 
more than one facility or collective of health care providers);
    (2) The local markets/organizations/services/vendors providing 
fresh fruits and vegetables and/or traditional foods;
    (3) The screening and enrollment process--how will the participants 
be selected? Who (e.g., participants with diabetes, only pregnant moms, 
only adults, youth/adults/both, etc.) and how many will be eligible?
    (a) What is the recruitment process for participants into P4? Based 
on estimates, how many participants can be accommodated during the 
budget year?
    (b) What will the prescription/voucher look like? Vouchers or 
actual fresh produce or other means? How long is the prescription/
voucher for and what is the dollar value?
    (c) How will the prescription be filled? Is it a voucher redemption 
at a participating vendor? Or a Farmer's Market arrangement with weekly 
pick up or delivery? How are the participating vendors reimbursed?
    (4) What are the plans for encouraging and providing fruits and 
vegetables and traditional foods in P4? Are there resources that can 
provide bulk supplies or will participants seek these foods on their 
own? What are the plans to provide fruits and vegetables, along with 
traditional foods, to help ensure a balance of both?
    (5) The implementation process--how will participants navigate the 
system? What is required of each participant that enrolls in the 
program? What will the nutrition education program look like? Will it 
be individual and/or group sessions? Who will conduct the training and 
how often? Will there be a pre-test/post-test for the participants and 
what will it include? If not, how will effectiveness of the education 
program be measured over time?
    (6) Participant and staff nutrition training process;
    (7) Duration of program; and is there a participant retention plan?
    (8) Staffing plan; and
    (9) Anticipated barriers/challenges and possible solutions--
geographic accessibility/food deserts, considerations for disability, 
transportation, etc.
Part 3: Evaluation (Limit--5 Pages)
Program Evaluation
    Describe the plan for collecting data, monitoring, and assuring 
quality and quantity of data and the plan for evaluating and reporting 
the program's outcomes.
    (1) Evaluation plan should include tracking and trending outcome 
data, such as (but not limited to):
    (a) Prescription redemption and dollar amount or other value;
    (b) Fruit and vegetable consumption (at baseline and at regular 
intervals throughout the participants involvement);
    (c) Participant recruitment and retention;
    (d) Food security, based on the outcomes of the U.S. Adult Food 
Security Survey Module (https://www.ers.usda.gov/media/8279/ad2012.pdf);
    (e) Patient experience/satisfaction;
    (f) Nutrition knowledge assessments over time;
    (g) Implementation cost;
    (h) Health outcomes/clinical markers (e.g. HbA1c, blood pressure, 
BMI, waist circumference, etc.) at baseline and then annually; and
    (i) Health care utilization patterns.
Part 4: Organizational Capabilities (Limit--5 Pages)
    Describe the broader capacity of the organization to complete the 
project outlined in the work plan, including:
    (1) Identification and biosketches for key personnel responsible 
for completing tasks;
    (2) Description of the structure of the organization and chain of 
responsibility for successful completion of the project outline in the 
work plan;
    (3) Description of financial and project management capacity, 
including information regarding similarly sized projects in scope and 
financial assistance as well as other awards and projects successfully 
completed;
    (4) Description of national experience in providing administrative 
and support services to Tribal programs, education agencies, and other 
Tribal programs for the benefit of AI/AN people and Tribal communities 
(indicate experience in national partnerships or national support 
efforts on behalf of AI/AN communities especially as it pertains to 
nutrition concerns);
    (5) Description of equipment and space available for use during the 
proposed project; and
    (6) Description of specialized experience working with Produce 
Prescription programs.
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 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, 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 not allowable.
     The available funds are inclusive of direct and indirect 
costs.

[[Page 24817]]

     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 
waiver approval from 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 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 the System for Award 
Management (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 to 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 recipients to report 
information on sub-awards. Accordingly, all IHS recipients must notify 
potential first-tier sub-recipients that no entity may receive a first-
tier sub-award unless the entity has provided its UEI number to the 
prime recipient 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 100 possible points. Points are 
assigned as follows:

1. Evaluation Criteria

A. Introduction and Needs Assessment (20 Points)
    This section should provide a clear description of the need for a 
Produce Prescription Program in the AI/AN community.
    (1) Did the applicant describe the profile of community 
socioeconomic and demographic and diet-related health illness 
characteristics, as well as the community food resources?
    (2) Did the applicant provide information about food resource 
accessibility, availability, and affordability?
B. Program Description and Operational Plan (30 Points)
    This section should demonstrate a sound and effective program 
operational plan that will support accomplishment of deliverables and 
milestones of the P4. A clear and concise description of the following 
should be provided:
    (1) The health care facility and local markets, organizations, 
services, and/or vendors providing fresh fruits and vegetables and/or 
traditional foods;
    (2) The recruitment, screening, and enrollment process;
    (3) The program implementation of prescribing by health care 
providers and redeeming fresh fruits and vegetables and/or traditional 
foods (if applicable) by participants (the target group);
    (4) The staffing plan to implement the program as well as the 
process for

[[Page 24818]]

nutrition training and education to participants and program staff; and
    (5) Anticipated barriers/challenges and possible solutions.
C. Evaluation Plan (20 Points)
    This section should describe the plan for collecting data, 
monitoring, and assuring quality and quantity of data, and the plan for 
evaluating and reporting the program's outcomes.
D. Organizational Capabilities (20 Points)
    This section should outline the broader capacity of the 
organization to complete the project outlined in the work plan. It 
includes the identification of personnel responsible for completing 
tasks and the chain of responsibility for successful completion of the 
project outline in the work plan. The section should clearly described 
the following:
    (1) The structure of the organization;
    (2) The ability of the organization to manage the proposed project 
and included information regarding similarly sized projects in scope 
and financial assistance as well as other awards and projects 
successfully completed;
    (3) What equipment (e.g., phone, websites, etc.) and facility space 
(e.g., office space) will be available for use during the proposed 
project. Include information about any equipment not currently 
available that will be purchased throughout the agreement;
    (4) Provide a list and biographical sketches for key personnel who 
will work on the project; and
    (5) Demonstrate knowledge in:
    (i) Providing administrative and support services to Tribal 
programs, education agencies, and other programs for the benefit of AI/
AN people and Tribal communities (indicate experience in national 
partnerships or national support efforts on behalf of AI/AN communities 
especially as it pertains to health concerns); and
    (ii) Financial and project management.
E. Categorical Budget and Budget Justification (10 Points)
    This section should provide a clear estimate of the project program 
costs and justification for expenses for the entire cooperative 
agreement period. The budget and budget justification should be 
consistent with the tasks identified in the work plan.
    (1) Categorical budget (Form SF-424A, Budget Information Non-
Construction Programs) completed for the first budget period.
    (2) Narrative justification for all costs, explaining why each line 
item is necessary or relevant to the proposed project. Include 
sufficient details to facilitate the determination of cost 
allowability.
    (3) Indication of any special start-up costs.
    (4) Budget justification should include a description of the 
planned costs and how those costs relate to or support the proposed 
project activities.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Timeline for proposed objectives.
     Current Indirect Cost Rate Agreement.
     Map of area identifying project location(s).
     Additional documents to support narrative (i.e., data 
tables, key news articles, etc.).
     Additional letters of support and assistance
     Financial statements
     Other similar project documents (e.g., budgets)

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 Review 
Committee (RC) 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 RC 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 DDTP within 30 days of the conclusion of the RC 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 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:
     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/

[[Page 24819]]

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.

2. Indirect Costs

    This section applies to all recipients 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 award 
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 2 CFR 200.414(f) Indirect (F&A) costs,

any non-Federal entity (NFE) [i.e., applicant] that does not have a 
current negotiated 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 200.403, 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 can be used by 
applicants that have 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 
award.
    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 recipients 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 write 
to [email protected].

3. Reporting Requirements

    The recipient 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 recipient 
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 annually. The progress 
reports are due within 90 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 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.
    Recipients 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 pilot program will develop their own unique plan for collecting 
data, monitoring, and assuring quality and quantity of data and the 
plan for evaluating and reporting the program's outcomes. The plan 
should include tracking and trending outcome data at baseline, 
semiannually, and annually. Data should include (but is not limited 
to):
    (1) Prescription redemption and dollar amounts;
    (2) Fruit and vegetable consumption;
    (3) Participant retention rates;
    (4) Food security via a validated measurement tool/survey;
    (5) Patient experience/satisfaction results;
    (6) Nutrition knowledge assessments over time;
    (7) Implementation cost;
    (8) Health outcomes/clinical markers (e.g. HbA1c, blood pressure, 
weight, BMI, waist circumference, etc.); and
    (9) Health care utilization patterns.
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 recipients of Federal awards 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/.

[[Page 24820]]

E. Non-Discrimination Legal Requirements for Awardees of Federal 
Financial Assistance
    The recipient 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 
recipient 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 recipients 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-
5204, 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: Ms. 
Carmen Licavoli Hardin, Director, Indian Health Service, Division of 
Diabetes Treatment and Prevention, 5600 Fishers Lane, Mail Stop: 
08N34A&B, Rockville, MD 20897, Phone: 1-844-IHS-DDTP (1-844-447-3387), 
Fax: 301-594-6213, 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: 09E70, Rockville, MD 20857, 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].
    4. For technical assistance with GrantSolutions, please contact the 
GrantSolutions help desk at (866) 577-0771, or by email at 
[email protected].

VIII. Other Information

    The Public Health Service strongly encourages all grant, 
cooperative agreement, and contract recipients 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, or 
early childhood development services are provided to children. This is 
consistent with the HHS mission to

[[Page 24821]]

protect and advance the physical and mental health of the American 
people.

P. Benjamin Smith,
Deputy Director, Indian Health Service.
[FR Doc. 2023-08614 Filed 4-21-23; 8:45 am]
BILLING CODE 4165-16-P