Community Health Aide Program: Tribal Assessment & Planning, 29673-29681 [2023-09721]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 88, Number 88 (Monday, May 8, 2023)]
[Notices]
[Pages 29673-29681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-09721]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Community Health Aide Program: Tribal Assessment & Planning

    Announcement Type: New.
    Funding Announcement Number: HHS-2023-IHS-TAP-0001.
    Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) 
Number: 93.382.

Key Dates

    Application Deadline Date: August 7, 2023.
    Earliest Anticipated Start Date: September 20, 2023.

I. Funding Opportunity Description

Statutory Authority

    The Indian Health Service (IHS) is accepting applications for 
grants for the Community Health Aide Program (CHAP) Tribal Assessment 
and Planning (TAP) program. 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. 1616l. The Assistance Listings 
section of SAM.gov (https://sam.gov/content/home) describes this 
program under 93.382.

Background

    The national CHAP will provide a network of health aides trained to 
support licensed health professionals while providing direct health 
care, health promotion, and disease prevention services. These 
providers will work within a referral relationship under the 
supervision of licensed clinical providers that includes clinics, 
service units, and hospitals. The CHAP aides increased access to direct 
health services, including inpatient and outpatient visits.
    The Alaska CHAP has become a model for efficient and high quality 
health care delivery in rural Alaska providing approximately 300,000 
patient encounters per year and responding to emergencies 24 hours a 
day, 7 days a week. Specialized providers in dental and behavioral 
health were later introduced to respond to the needs of patients and 
address the health disparities in oral health and mental health amongst 
American Indian and Alaska Natives.
    The national CHAP is a workforce model that includes three 
different provider types that act as extenders of their licensed 
clinical supervisor. The national CHAP currently includes a behavioral 
health aide, community health aide, and dental health aide. Each of the 
health aide categories operate in a tiered level practice system. The 
national CHAP model provides an opportunity for increased access to 
care through the extension of primary care, dental, and behavioral 
health clinicians.
    In 2010, under the permanent reauthorization of the Indian Health 
Care Improvement Act (IHCIA), Congress provided the Secretary of Health 
and Human Services, acting through the IHS, the authority to expand the 
CHAP nationally. In 2016, the IHS initiated Tribal Consultation on 
expanding the CHAP to the contiguous 48 states. In 2018, the HIS formed 
the CHAP Tribal Advisory Group (TAG) and began developing the program. 
In 2020, the IHS announced the national CHAP policy, which formally 
created the national CHAP.

Purpose

    The TAP program purpose is to support the assessment and planning 
of Tribes and Tribal Organizations (T/TO) in determining the 
feasibility of implementing CHAP in their respective communities. The 
program is designed to support the regional flexibility required for T/
TO to design a program unique to the needs of their individual 
communities across the country through the identification of 
feasibility factors.
    The focus of the program is to:
    Part 1: Assess whether the T/TO can integrate CHAP into the Tribal 
health system including the health care workforce.
    Part 2: Identify systemic barriers that prohibit the complete 
integration of CHAP into an existing health care system. The barriers 
should be related to:
     Clinical infrastructure.
     Workforce barriers.
     Certification of providers.
     Training of providers.
     Inclusion of culture in the services provided by a CHAP 
provider.
    Part 3: Plan partnerships across the T/TO geographic region to 
address the barriers including reimbursement, training, education, 
clinical infrastructure, implementation cost, and determination of 
system integration.

II. Award Information

Funding Instrument--Grant

Estimated Funds Available
    The total funding identified for fiscal year (FY) 2023 is 
approximately $1,500,000. Individual award amounts for the first budget 
year are anticipated to be between $250,000 and $500,000. The funding 
available for competing and subsequent continuation awards issued under 
this announcement is subject to the availability of appropriations and 
budgetary priorities

[[Page 29674]]

of the Agency. The IHS is under no obligation to make awards that are 
selected for funding under this announcement.
Anticipated Number of Awards
    The IHS anticipates issuing approximately three to five awards 
under this program announcement.
Period of Performance
    The period of performance is for 2 years.

III. Eligibility Information

1. Eligibility

    To be eligible for this funding opportunity applicant must be one 
of the following, as defined by 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 (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.
    The Division of Grants Management (DGM) will notify any applicants 
deemed ineligible.

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 TAP 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.
    Specifically, an applicant may not apply to both this opportunity, 
TAP, and the CHAP Tribal Planning and Implementation (TPI) opportunity 
(number HHS-2023-IHS-TPI-0001).
    An organization currently carrying out a CHAP in the U.S. in 
accordance with 25 U.S.C. 1616l through an Indian Self-Determination 
and Education Assistance Act (ISDEAA) agreement is not eligible to 
apply.

    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 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 T/TO 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 objective review and in 
processing awards. Upload all requested and optional documents 
individually, rather than combining them into a single file. Creating a 
single file creates confusion when trying to find specific documents. 
Such confusion can contribute to delays in processing awards, and could 
lead to lower scores during the objective review.

1. Obtaining Application Materials

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

2. Content and Form Application Submission

    Mandatory documents for all applicants include:
     Application forms:
    1. SF-424, Application for Federal Assistance.
    2. SF-424A, Budget Information--Non-Construction Programs.
    3. SF-424B, Assurances--Non-Construction Programs.
    4. Project Abstract Summary form.
     Project Narrative (not to exceed 15 pages). See section 
IV.2.A, Project Narrative for instructions.
    1. Background information on the organization.
    2. Proposed scope of work, objectives, and activities that provide 
a description of what the applicant plans to accomplish.

[[Page 29675]]

     Budget Narrative (not to exceed 5 pages). See section 
IV.2.B, Budget Narrative for instructions.
     One-page Timeframe Chart.
     Tribal Resolution(s) as described in section III, 
Eligibility.
     Letters of Support from organization's Board of Directors.
     501(c)(3) Certificate.
     Biographical sketches for all Key Personnel.
     Contractor/Consultant resumes or qualifications and scope 
of work.
     Disclosure of Lobbying Activities (SF-LLL), if applicant 
conducts reportable lobbying.
     Certification Regarding Lobbying (GG-Lobbying Form).
     Copy of current Negotiated Indirect Cost (IDC) rate 
agreement (required in order to receive IDC).
     Organizational Chart (optional).
     Documentation of current Office of Management and Budget 
(OMB) Financial Audit (if applicable).
    Acceptable forms of documentation include:
    1. Email confirmation from Federal Audit Clearinghouse (FAC) that 
audits were submitted; or
    2. Face sheets from audit reports. Applicants can find these on the 
FAC website at https://facdissem.census.gov/ 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 15 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 15-page limit for the 
project narrative does not include the 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.
Part 1: Program Information (limit--4 pages)
    Describe the community and how it would benefit from the 
implementation of CHAP. Describe the community's current health 
disparities relating to primary, behavioral, and oral health care. 
Describe the T/TO's current health program activities, how long it has 
been operating and what programs or services are currently being 
provided. Describe in full the organization's infrastructure and its 
ability to identify and assess the barriers that could impact or 
prohibit the integration of CHAP.
Part 2: Program Planning and Evaluation (limit--6 pages)
Section 1: Program Plans
    Describe in full the direction the T/TO plans to take in the CHAP 
TAP. The program plan should first clearly identify the problems within 
the community related to behavioral, primary, and oral health. The 
program plan should then include the plan to assess problem(s). This 
should include a timeline for the assessment. The program plan should 
identify a timeline to determine whether CHAP can address the barriers 
identified.
Section 2: Program Activities
    Describe in full the activities to identify problems creating 
barriers within the community related to behavioral, primary, and oral 
health. These activities should be categorized (at a minimum) within 
key factors related to clinical infrastructure, workforce barriers, 
training infrastructure, and cultural inclusion. Describe in full how 
the applicant plans to assess the problems identified. Finally, 
describe in detail the activities and associated timeline to determine 
whether CHAP is feasible and activities to quantify the cost associated 
with CHAP. The program activities should detail which partners will aid 
in identifying and assessing barriers related to clinical 
infrastructure, workforce barriers, training infrastructure, and 
cultural inclusion.
Section 3: Staffing Plan
    Describe key staff tasked with carrying out the program activities 
in section 2. Applicants should account for potential stakeholder 
partnerships following the assessment of barriers in the staffing plan.
Section 4: Timeline
    Describe a timeline not to exceed two years for the completion of 
the program plan, activities, and evaluation plan. Provide a timeline 
chart depicting a realistic timeline that details all major activities, 
milestones, and applicable staffing plans. The timeline should include 
the projected progress report due at the midpoint of the project 
period. The timeline chart should not exceed one page.
Section 5: Program Evaluation
    The evaluation plan should identify and describe significant 
program activities and achievements associated with the assessment and 
planning of whether CHAP can address identified barriers within the 
existing T/TO health system. The evaluation plan should organize all 
identified problems that lead to barriers into major categories related 
to clinical infrastructure, workforce barriers, training 
infrastructure, and cultural inclusion specific to the scope of 
practice of prospective CHAP providers. The evaluation plan should 
detail how these barriers can be quantified. The evaluation plan should 
outline a tentative plan on how the barriers can be overcome. Include 
plans to incorporate CHAP into the existing infrastructure and where 
new infrastructure will need to be built, where and how new workforce 
can be recruited and/or developed if needed, where and how training for 
new CHAP providers will be developed, how existing workforce will be 
trained to support and integrate the CHAP program and how culture will 
be integrated throughout the components. The evaluation plan should 
detail how the applicant will measure the assessment of whether CHAP 
can address the issues identified including number of partnerships for 
each major category of barriers, other factors that may impact 
feasibility, and sustainability. Finally, the evaluation plan should 
detail how the applicant plans to calculate the total cost associated 
with integrating CHAP as part of the planning process.

[[Page 29676]]

Part 3: Program Report (limit--5 pages)
    Section 1: Describe your organization's significant program 
activities and accomplishments over the past 2 years associated with 
the goals of this announcement.
    At the conclusion of the program period, using the findings from 
the evaluation, the T/TO should determine the feasibility of 
implementing a CHAP within the T/TO's community. The Outcome Report 
should describe in full the findings of the program plan, evaluation, 
and determination on stage of readiness for implementation. The 
findings should select from one of the following readiness assessment 
levels:
    1. The CHAP program is not a good fit for the needs of the 
organization and/or the organization will not be ready to implement the 
CHAP program in the foreseeable future.
    2. The organization would be a good fit for the CHAP program but 
the organization has a great deal of work to do in preparation for the 
implementation of the CHAP program.
    3. The findings show multiple areas of organizational readiness for 
the implementation of the CHAP program.
    The outcome report should organize the findings into at least 5 
categories:
    (1) Clinical Infrastructure: Describe assessments of clinical 
infrastructure and plans for how to implement the CHAP program with the 
current or modified clinical infrastructure. Include information as to 
the facility workspace, information technology, transportation concerns 
for CHAP providers, program collaborations, Area-level administration, 
clinic staffing and leadership, legislative issues, and any other 
infrastructure items relevant to the successful implementation of the 
CHAP.
    (2) Workforce Barriers: Describe assessments of workforce barriers 
regarding the implementation of a CHAP program within the organization 
and any proposed changes. Include information on identified recruitment 
opportunities and partnerships, information on human resource ability 
to manage additional recruitment activities, specifics relating to 
capacity to provide CHAP supervision and ability to provide support for 
students for any identified needs (such as transportation, childcare, 
etc.), which may limit ability of potential CHAP providers to engage in 
CHAP activities, and any other factors impacting the implementation of 
a CHAP program.
    (3) Training Infrastructure: Assess all identified realistic 
sources for training of CHAP providers. Include any Tribal Colleges and 
Universities, non-tribal institutions, other Tribal or non-tribal 
training programs and any other resources, both local and non-local if 
relationships are realistic for a sustainable CHAP program. Include 
information on whether training would be in-situ, virtual or a hybrid 
model. Include information on both classroom and hands-on skills-based 
training. Also include information on supervisory training and 
continuing education training.
    (4) Cultural Inclusion: Detail assessment and plans to incorporate 
cultural elements throughout all aspects of the CHAP program, both in 
the training of CHAP providers and in all aspects of the delivery of 
care through the CHAP program throughout the organization.
    (5) Implementation Cost: Based on the findings and measurable 
outcomes of the categories, the applicant should explicitly identify 
whether CHAP is feasible for implementation into the T/TO's respective 
community. Applicants should develop an organized report that 
highlights the categories succinctly and includes data (quantitative or 
qualitative) from the evaluation plan. The evaluation plan should 
outline a tentative plan on how the barriers can be overcome if 
applicable. The outcome report should explicitly detail the cost 
associated with integrating CHAP if it is found that CHAP can address 
the barriers identified in the assessment phase. Provide a comparison 
of the actual accomplishments to the goals established for the project 
period, or if applicable, provide justification for the lack of 
progress.
    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 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 grant 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

[[Page 29677]]

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 2-5 weeks to 
become active. Please see SAM.gov for details on the registration 
process and timeline. Registration with the SAM is free of charge but 
can take several weeks to process. Applicants may register online at 
https://sam.gov.
Unique Entity Identifier
    Your SAM.gov registration now includes a Unique Entity Identifier 
(UEI), generated by SAM.gov, which replaces the DUNS number obtained 
from Dun and Bradstreet. SAM.gov registration no longer requires a DUNS 
number.
    Check your organization's SAM.gov registration as soon as you 
decide to apply for this program. If your SAM.gov registration is 
expired, you will not be able to submit an application. It can take 
several weeks to renew it or resolve any issues with your registration, 
so do not wait.
    Check your Grants.gov registration. Registration and role 
assignments in Grants.gov are self-serve functions. One user for your 
organization will have the authority to approve role assignments, and 
these must be approved for active users in order to ensure someone in 
your organization has the necessary access to submit an application.
    The Federal Funding Accountability and Transparency Act of 2006, as 
amended (``Transparency Act''), requires all HHS awardees to report 
information on sub-awards. Accordingly, all IHS awardees must notify 
potential first-tier sub-recipients 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)
    Identify the proposed project and plans to identify the feasibility 
of implementing a CHAP within the T/TO community. The needs should 
clearly identify the existing health system and how the CHAP may be a 
viable workforce model for the community needs.
    The feasibility report should organize the findings into at least 
five categories:
    a. Clinical Infrastructure: Describe assessments of clinical 
infrastructure and plans for how to implement the CHAP program with the 
current or modified clinical infrastructure. Include information as to 
the facility workspace, information technology, transportation concerns 
for CHAP providers, program collaborations, Area-level administration, 
clinic staffing and leadership, legislative issues and any other 
infrastructure items relevant to the successful implementation of the 
CHAP.
    b. Workforce Barriers: Describe assessments of workforce barriers 
regarding the implementation of a CHAP program within the organization 
and any proposed changes. Include information on identified recruitment 
opportunities and partnerships, information on human resource ability 
to manage additional recruiting activities, specifics relating to 
capacity to provide CHAP supervision and ability to provide support for 
students for any identified needs (such as transportation, childcare, 
etc.), which may limit ability of potential CHAP providers to engage in 
CHAP activities and any other factors impacting the implementation of a 
CHAP program.
    c. Training Infrastructure: Assess all identified realistic sources 
for training of CHAP providers. Include any Tribal Colleges and 
Universities, non-tribal institutions, other tribal training programs 
and any other resources, both local and non-local if relationships are 
realistic for a sustainable CHAP program. Include information on 
whether training would be in-situ, virtual or a hybrid model. Include 
information on both classroom and hands-on skills-based training. Also 
include information on supervisory training and continuing education 
training.
    d. Cultural Inclusion: Detail assessment and plans to incorporate 
cultural elements throughout all aspects of the CHAP program, both in 
the training of CHAP providers and in all aspects of the delivery of 
care through the CHAP program throughout the organization.
    e. Implementation Cost: Based on the findings and measurable 
outcomes of the categories, the applicant should explicitly identify 
whether CHAP is feasible for implementation into the T/TO's respective 
community. Applicants

[[Page 29678]]

should develop an organized report that highlights the categories 
succinctly and includes data (quantitative or qualitative) from the 
evaluation plan. The evaluation plan should outline a tentative plan on 
how the barriers can be overcome if applicable. The outcome report 
should explicitly detail the cost associated with integrating CHAP if 
it is found that CHAP can address the barriers identified in the 
assessment phase. Provide a comparison of the actual accomplishments to 
the goals established for the project period, or if applicable, provide 
justification for the lack of progress.
B. Project Objective(s), Work Plan and Approach (30 points)
    The work plan should be comprised of two key parts: Program 
Information and Program Plan. Acceptable Program Information should 
provide information related to three key sections: community profile; 
health and infrastructure; and organizational capacity. The Program 
Information part should demonstrate a robust community profile that 
highlights the existing health system, demographic data of community 
members and user population, and a detail of the T/TO carrying out the 
proposed activity. An acceptable Program Plan should include details of 
the applicant's plan to address the program objective. The Program Plan 
should address, at a minimum, key activities related to clinical 
infrastructure, workforce barriers, and training infrastructure.
C. Program Evaluation (30 points)
    The program evaluation should address how the applicant intends to 
measure major categories related to clinical infrastructure, workforce 
barriers, training infrastructure, cultural inclusion (See Sample Logic 
Model in Appendix Related Documents in Grants.gov) specific to the 
scope of practice of prospective CHAP providers, and implementation 
costs. The evaluation plan should identify how the applicant plans to 
determine the feasibility of CHAP integration into the Tribal system, 
measurement of significant systematic barriers, implementation cost 
associated with CHAP, and planning for the scope of work. List 
measurable and attainable goals with explicit timelines that detail 
expectation of findings. The program evaluation report should organize 
the findings into at least 5 categories:
    a. Clinical Infrastructure: Describe assessments of clinical 
infrastructure and plans for how to implement the CHAP program with the 
current or modified clinical infrastructure. Include information as to 
the facility workspace, information technology, transportation concerns 
for CHAP providers, program collaborations, Area-level administration, 
clinic staffing and leadership, legislative issues and any other 
infrastructure items relevant to the successful implementation of the 
CHAP.
    b. Workforce Barriers: Describe assessments of workforce barriers 
regarding the implementation of a CHAP program within the organization 
and any proposed changes. Include information on identified recruitment 
opportunities and partnerships, information on human resource ability 
to manage additional recruiting activities, specifics relating to 
capacity to provide CHAP supervision and ability to provide support for 
students for any identified needs (such as transportation, childcare, 
etc.), which may limit ability of potential CHAP providers to engage in 
CHAP activities and any other factors impacting the implementation of a 
CHAP program.
    c. Training Infrastructure: Assess all identified realistic sources 
for training of CHAP providers. Include any Tribal Colleges and 
Universities, non-tribal institutions, other tribal training programs 
and any other resources, both local and non-local if relationships are 
realistic for a sustainable CHAP program. Include information on 
whether training would be in-situ, virtual or a hybrid model. Include 
information on both classroom and hands-on skills-based training. Also 
include information on supervisory training and continuing education 
training.
    d. Cultural Inclusion: Detail assessment and plans to incorporate 
cultural elements throughout all aspects of the CHAP program, both in 
the training of CHAP providers and in all aspects of the delivery of 
care through the CHAP program throughout the organization.
    e. Implementation Cost: Based on the findings and measurable 
outcomes of the categories, the applicant should explicitly identify 
whether CHAP is feasible for implementation into the T/TO's respective 
community. Applicants should develop an organized report that 
highlights the categories succinctly and includes data (quantitative or 
qualitative) from the evaluation plan. The evaluation plan should 
outline a tentative plan on how the barriers can be overcome if 
applicable.
D. Organizational Capabilities, Key Personnel, and Qualifications (10 
Points)
    Provide a detailed biographical sketch of each member of key 
personnel assigned to carry out the objectives of the program plan. The 
sketches should detail the qualifications and expertise of identified 
staff.
E. Categorical Budget and Budget Justification (20 Points)
    Provide a detailed budget of each expenditure directly related to 
the identified program activities.
    Additional documents can be uploaded as Other Attachments in 
Grants.gov. These can include:
     Work plan, logic model, and/or timeline for proposed 
objectives.
     Position descriptions for key staff.
     Resumes of key staff that reflect current duties.
     Consultant or contractor proposed scope of work and letter 
of commitment (if applicable).
     Current Indirect Cost Rate Agreement.
     Organizational chart.
     Map of area identifying project location(s).
     Additional documents to support narrative (i.e., data 
tables, key news articles, etc.).

2. Review and Selection

    Each application will be prescreened for eligibility and 
completeness as outlined in the funding announcement. Applications that 
meet the eligibility criteria shall be reviewed for merit by the 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 Office of Clinical and Preventative Services (OCPS) 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

[[Page 29679]]

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/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 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 30 days after the reporting period ends 
(specific dates will be listed in the NoA Terms and Conditions). These 
reports must include a brief comparison of actual accomplishments to 
the goals established for the period, a summary of progress to date or, 
if applicable, provide sound justification for the lack of progress, 
and other pertinent information as required. A final report must be 
submitted within 120 days of the period of performance end date.
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.

[[Page 29680]]

    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
    To satisfy the reporting requirements, the applicant is expected to 
develop an outcome report. The outcome report should explicitly state 
whether CHAP implementation and integration into existing healthcare 
system is viable or not. The Outcome Report should describe in full the 
findings of the program plan, evaluation, and determination on stage of 
readiness for implementation. The Outcome Report should organize the 
findings into at least five categories:
    1. Clinical Infrastructure.
    2. Workforce Barriers.
    3. Training Infrastructure.
    4. Cultural Inclusion.
    5. Implementation Cost.
    Applicants are encouraged to identify additional categories above 
the five aforementioned and may choose to develop subcategories that 
best fit the program plan.
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 grants to 
report information about first-tier sub-awards and executive 
compensation under Federal assistance awards.
    The IHS has implemented a Term of Award into all IHS Standard Terms 
and Conditions, NoAs, and funding announcements regarding the FSRS 
reporting requirement. This IHS Term of Award is applicable to all IHS 
grant and cooperative agreements issued on or after October 1, 2010, 
with a $25,000 sub-award obligation threshold met for any specific 
reporting period.
    For the full IHS award term implementing this requirement and 
additional award applicability information, visit the DGM Grants 
Management website at https://www.ihs.gov/dgm/policytopics/.
E. Non-Discrimination Legal Requirements for Awardees of Federal 
Financial Assistance
    The 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,

[[Page 29681]]

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:

Donna E. Enfield, Public Health Advisor, Office of Clinical and 
Preventative Services, 5600 Fishers Lane, Rockville, MD 20857, Phone: 
(301) 526-6966, 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 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, 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. 2023-09721 Filed 5-5-23; 8:45 am]
BILLING CODE 4165-16-P