[Federal Register Volume 62, Number 29 (Wednesday, February 12, 1997)]
[Notices]
[Pages 6536-6539]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-3522]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Office of the Secretary, Office of Minority Health; Availability 
of Funds for Grants for the Bilingual/Bicultural Service Demonstration 
Program (Managed Care)

AGENCY: Office of the Secretary.

ACTION: Notice of availability of funds and request for applications.

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AUTHORITY:  This program is authorized under section 1707(d)(1) of the 
Public Health Service Act, as amended in Public Law 101-527, the 
Disadvantaged Minority Health Improvement Act of 1990.

PURPOSE: The purpose of this Fiscal Year 1997 Bilingual/Bicultural 
Service Demonstration Grant Program (Managed Care) is to:
    (1) provide support to improve and expand the capacity and ability 
of health care providers and other health care professionals to deliver 
linguistically and culturally competent health services to limited-
English-proficient populations; and
    (2) increase the limited-English-proficient populations' knowledge 
and understanding about managed care and its implications, including 
the different managed care models/plans that exist, so they can make 
informed decisions about their health care.
    These grants are intended to demonstrate the merit of programs that 
involve partnerships between minority community-based organizations and 
health care facilities in a collaborative effort to address cultural 
and linguistic barriers to effective health care service delivery and 
to increase access to effective health care for the limited-English-
proficient populations living in the United States.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS-led national activity to reduce morbidity and mortality and 
to improve the quality of life. Potential applicants may obtain a copy 
of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or 
Healthy People 2000: Midcourse Review and 1995 Revisions (Stock No. 
017-001-00526-6) through the Superintendent of Documents, Government 
Printing Office, Washington, D.C. 20402-9325 or telephone (202) 783-
8238.

ELIGIBLE APPLICANTS: Public and private, nonprofit minority community-
based organizations which have an established linkage with a health 
care facility serving a targeted minority community with limited-
English-proficient populations. Applicants must be located within one 
of the following top 15 Metropolitan Statistical Areas identified from 
the 1990 U.S. Census as having the highest number of limited-English-
proficient households experiencing linguistic isolation:
    <bullet> Phoenix, AZ.
    <bullet> Fresno, CA.
    <bullet> Los Angeles/Anaheim/Riverside, CA.
    <bullet> Sacramento, CA.
    <bullet> Honolulu, HI.
    <bullet> Boston/Lawrence/Salem, MA-NH.
    <bullet> Detroit/Ann Arbor, MI.
    <bullet> New York/North New Jersey/Long Island, NY-NJ-CT.
    <bullet> Philadelphia/Wilmington/Trenton, PA-NJ-DE-MD.
    <bullet> Dallas/Ft. Worth, TX.
    <bullet> El Paso, TX.
    <bullet> Houston/Galveston/Brazoria, TX.
    <bullet> McAllen/Edinburg/Mission, TX.
    <bullet> Seattle/Tacoma, WA.
    <bullet> Washington, DC Metropolitan Statistical Area.
    National organizations are not eligible to apply; however, local 
affiliates of national organizations which have an established link 
with a health care facility are eligible to apply. Currently funded OMH 
Bilingual/Bicultural Service Demonstration Program grantees are not 
eligible to apply.

DEADLINE: To receive consideration, grant applications must be received 
by the OMH Grants Management Office by April 11, 1997. Applications 
will be considered as meeting the deadline if they are: (1) received on 
or before the established deadline date and received in time for 
orderly processing. Applicants should request a legibly dated U.S. 
Postal Service postmark or obtain a legibly dated receipt from a 
commercial carrier or the U.S. Postal Service. Private metered 
postmarks shall not be acceptable as proof of timely mailing. 
Applications submitted by facsimile transmission (FAX) or any other 
electronic format will not be accepted. Applications which do not meet 
the deadline will be considered late and will be returned to the 
applicant unread.

ADDRESSES/CONTACTS: Applications must be prepared using Form PHS 5161-1 
(Revised July 1992 and approved by OMB under control Number 0937-0189). 
Application kits and technical assistance on budget and business 
aspects of the application may be obtained from Ms. Carolyn A. 
Williams, Grants Management Officer, Division of Management Operations, 
Office of Minority Health, Rockwall II Building, Suite 1000, 5515 
Security Lane, Rockville, MD 20852, telephone (301) 594-0758. Completed 
applications are to be submitted to the same address.
    Questions regarding programmatic information and/or requests for 
technical assistance in the preparation of grant applications should be 
directed to Ms. Cynthia Amis, Director, Division of Program Operations, 
Office of Minority Health, Rockwall II Building, Suite 1000, 5515 
Security Lane, Rockville, Maryland 20852, telephone number (301) 594-
0769.
    The OMH Regional Minority Health Consultants (RMHCs) are also 
available to provide technical assistance. A listing of the RMHCs and 
how they may be contacted will be provided in the grant application 
kit. Applicants can contact the OMH Resource Center (OMH-RC) at 1-800-
444-6472 for health information.

AVAILABILITY OF FUNDS: Approximately $1.17 million is available for 
award in FY 1997. It is projected that awards of up to $100,000 total 
costs (direct and indirect) for a 12-month period will be made to 
approximately 10 to 12 competing applicants.

PERIOD OF SUPPORT: The start date for the Bilingual/Bicultural Service 
Demonstration Program (Managed Care) grants is September 30, 1997. 
Support may be requested for a total project period not to exceed 3 
years. Noncompeting continuation awards of up to $100,000 will be made 
subject to satisfactory performance and availability of funds.

BACKGROUND: Large numbers of minorities in the United States are

[[Page 6537]]

linguistically isolated. According to the 1990 U.S. Census, 31.8 
million persons or 13 percent of the total U.S. population (ages 5 and 
above) speak a language other than English at home. Almost 2 million 
people do not speak English at all and 4.8 million people do not speak 
English well. The 1990 U.S. Census also found that various minority 
populations and subgroups are linguistically isolated: approximately 4 
million Hispanics; approximately 1.6 million Asian and Pacific 
Islanders; approximately 282,000 Blacks; and approximately 77,000 
Native Americans. Based on the review of the statistics regarding 
linguistically isolated households across the United States, it has 
been determined that this announcement will focus on those top 15 
Metropolitan Statistical Areas in which the largest concentration of 
limited-English-proficient minority populations reside.
    In 1993, the Office of Minority Health launched its Bilingual/
Bicultural Service Demonstration Grant Program to specifically address 
the barriers that limited-English-proficient minority populations 
encounter when accessing health services. Besides the social, cultural 
and linguistic barriers, which significantly affect the delivery of 
adequate health care, there are other factors that contribute to the 
poor health status of limited-English-proficient minorities. These 
factors include:
    <bullet> Inadequate number of health care providers and other 
health care professionals skilled in culturally competent and 
linguistically appropriate delivery of services;
    <bullet> Scarcity of trained interpreters at the community level;
    <bullet> Deficiency of knowledge about appropriate mechanisms to 
address language barriers in health care settings;
    <bullet> Lack of culturally appropriate community health prevention 
programs;
    <bullet> Absence of effective partnerships between major mainstream 
provider organizations and limited-English-proficient minority 
communities;
    <bullet> Low economic status;
    <bullet> Lack of health insurance; and
    <bullet> Organizational barriers.
    Today, more and more people are receiving their health services 
through managed care--the integration of financing, management, and the 
delivery of health services, with providers taking on financial risk 
(OMH, Closing The Gap, Mar/Apr 1996). The Health Care Financing 
Administration (HCFA) is the largest purchaser of managed care in the 
country. According to HCFA's 1995 Medicaid Managed Care Enrollment 
Report, more than 11.6 million Medicaid beneficiaries are enrolled in 
Medicaid managed care plans. With this increased focus on providing 
health care service delivery via managed care, it is essential that 
limited-English-proficient minority populations adequately understand 
the intricacies of the managed care system.
    To make informed decisions, the target population will need to 
understand various concepts: for example, what managed care means, what 
are managed care entities, what types of managed care plans exist and 
what are the differences, what are the pros and cons of a managed care 
system, how to access services in a managed care setting, what is a 
provider network, and what are the rights of the client. For this 
information to be effective, it will need to be provided in linguistic 
and culturally sensitive and comprehensive formats appropriate for 
diverse populations.
    It is essential that health care providers, health care 
professionals and other staff (managed care or non-managed care) become 
informed about their diverse clientele from a linguistic, cultural, and 
medical perspective. By becoming culturally competent, health care 
providers can encourage this vulnerable population to more confidently 
access and receive appropriate health care.

Definitions

    For purposes of this grant announcement, the following definitions 
apply:
    Cultural Competency--A set of interpersonal skills that allow 
individuals to increase their understanding and appreciation of 
cultural differences and similarities within, among and between groups. 
This requires a willingness and ability to draw on community-based 
values, traditions and customs, and to work with knowledgeable persons 
of and from the community in developing focused interventions, 
communications and other supports. (Orlandi, Mario A., 1992.)
    Health Care Facility--A public nonprofit facility that has an 
established record for providing a full range of health care services 
to a targeted, limited-English-proficient, racial and ethnic minority 
community. Facilities providing only screening and referral activities 
are not included in this definition. A health care facility may be a 
hospital, outpatient medical facility, community health center, migrant 
health center, or a mental health center. (Federal Register, Vol. 60, 
No. 71, pg 18935, April 13, 1995.)
    Limited-English-Proficient Populations--Individuals (as defined in 
Minority Populations below) with a primary language other than English 
who must communicate in that language if the individual is to have an 
equal opportunity to participate effectively in and benefit from any 
aid, service or benefit provided by the health provider.
    Metropolitan Statistical Area--Comprises one or more counties 
containing either a place with at least 50,000 inhabitants, or an 
urbanized area and a metropolitan area of at least 100,000 (75,000 in 
New England). Contiguous counties are included if they have close 
social and economic links with the area's population nucleus. (U.S. 
Bureau of the Census, Factfinder for the Nation, CFF No. 8, March 
1991.)
    Minority Community-Based Organization--A public or private 
nonprofit community-based minority organization or a local affiliate of 
a national minority organization that has: a governing board composed 
of 51 percent or more racial/ethnic minority members, a significant 
number of minorities in key program positions, and an established 
record of service to a racial and ethnic minority community.
    Minority Populations--Asian/Pacific Islanders, Blacks, Hispanics, 
and American Indians/Alaska Natives. (OMB Statistical Policy Directive 
No. 15)

Project Requirements

    Each project funded under this demonstration grant is to:
    1. Carry out activities to improve the ability of health care 
providers and other health care professionals to delivery 
linguistically and culturally competent health care services to the 
target population. Potential activities may include: language and 
cultural competency training and curricula development using 
traditional and innovative training models, such as CD-ROMs, on-line 
formats for continuing education; bilingual health access or health 
promotion information in the native language; and on-site 
interpretation services.
    2. Carry out activities to educate the target population on the 
basic principles of managed care plans and services available within 
the targeted region. Potential activities may include: utilizing 
culturally and linguistically appropriate informational/communication 
technologies, such as mass media, public service announcements and 
neighborhood outreach and electronic systems including kiosks, as an 
educational tool; and conducting forums/seminars to promote information 
exchange among managed care organizations, health care

[[Page 6538]]

providers, advocacy groups, and consumers.
    3. Have an established, formal linkage with a health care facility, 
prior to submission of an application, for the purpose of ensuring that 
the target population is provided with a continuum of support for 
receiving appropriate health care services. Evidence of an established 
linkage should include signed letters of agreement written specifically 
to address the proposed projects and relevant activities.
    4. Have clearly defined and documented roles for the applicant 
(minority community-based organization), the health care facility and 
any other primary entity relevant to the proposed model.
    5. Develop an evaluation plan to assess process and outcome data.

Use of Grant Funds

    Budgets of up to $100,000 total costs (direct and indirect) per 
year may be requested to cover costs of: personnel, consultants, 
supplies, equipment, and grant-related travel. Funds may not be used 
for medical treatment, construction, building alterations, or 
renovations. All budget requests must be fully justified in terms of 
the proposed goals and objectives and include a computational 
explanation of how costs were determined.

Criteria for Evaluating Applications

    Review of Applications: Applications will be screened upon receipt. 
Those that are judged to be incomplete, nonresponsive to the 
announcement or nonconforming will be returned without comment. Each 
organization may submit no more than one proposal under this 
announcement. If an organization submits more than one proposal all 
will be deemed ineligible and returned without comment. Accepted 
applications will be reviewed for technical merit in accordance with 
PHS policies. Applications will be evaluated by an Objective Review 
Panel chosen for their expertise in minority health and managed care, 
and their understanding of the unique health problems and related 
issues confronted by the limited-English-proficient, racial and ethnic 
populations in the United States.
    Applicants are advised to pay close attention to the specific 
program guidelines and general and supplemental instructions provided 
in the application kit.
    Application Review Criteria: The technical review of applications 
will consider the following generic factors:

Factor 1: Background (15%)

    Adequacy of: demonstrated knowledge of the problem at the local 
level; demonstrated need within the proposed community and target 
population; demonstrated support and established linkages in order to 
conduct proposed model; and extent and documented outcome of past 
efforts/activities with the target population.

Factor 2: Goals and Objectives (15%)

    Delineation of specific objectives which are consistent with the 
goals of the program, and are measurable and outcome-oriented.

Factor 3: Methodology (35%)

    Comprehensiveness of proposed work plan and specific activities for 
each objective. Adequacy of the time line in relation to the objectives 
and program evaluation. Extent to which the applicant demonstrates 
access to the target population. Adequacy of the established linkages 
to provide the services. Delineation and clarity of defined roles for 
the applicant and the linked health care facility.

Factor 4: Evaluation (20%)

    Thoroughness, feasibility and appropriateness of the evaluation 
design from a methodological and data collection perspective. Extent to 
which the design allows a generalized conclusion regarding the outcomes 
in achieving the goals and objectives of the project. Potential for 
replication in other health care settings for the target population.

Factor 5: Management Plan (15%)

    Capability of the applicant organization for program management and 
evaluation of the project. Evidence of capabilities would be adequacy 
of: proposed management, frontline and evaluation staff qualifications 
or requirements of ``to be hired'' staff; proposed staff level of 
effort; and background and experience of proposed staff relevant to 
proposed activities.

Award Criteria

    Funding decisions will be determined by the Deputy Assistant 
Secretary of Minority Health, Office of Minority Health and will take 
under consideration: the recommendations/ratings of the review panels, 
geographic and race/ethnicity distribution, and health problem areas 
having the greatest impact on minority health. Consistent with the 
Congressional intent of Public Law 101-527, section 1707(c)3, special 
consideration will be given to projects targeting Asian, American 
Samoan, and other Pacific Islander populations. Special consideration 
will also be given to projects proposed to be implemented in 
Empowerment Zones/Empowerment Communities.

Reporting and Other Requirements

General Reporting Requirements

    A successful applicant under this notice will submit: (1) an annual 
progress report and Financial Status Report, and (2) a final project 
report and Financial Status Report in the format established by the 
Office of Minority Health, in accordance with provisions of the general 
regulations which apply under ``Monitoring and Reporting Program 
Performance,'' 45 CFR Part 74, Subpart J, with the exception of State 
and local governments to which 45 CFR Part 92, Subpart C reporting 
requirements apply.

Provision of Smoke-Free Workplace and Non-use of Tobacco Products by 
Recipients of PHS Grants

    The Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and to promote the nonuse 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 a facility) in which regular or routine education, library, 
day care, health care or early childhood development services are 
provided to children.

Public Health System Reporting Requirements

    This program is subject to Public Health Systems Reporting 
Requirements which have been approved by the Office of Management and 
Budget under No. 0937-0195. Under these requirements, a community-based 
nongovernmental applicant must prepare and submit a Public Health 
System Impact Statement (PHSIS). The PHSIS is intended to provide 
information to State and local health officials to keep them apprised 
of proposed health services grant applications submitted by community-
based nongovernmental organizations within their jurisdictions.
    Community-based, nongovernmental applicants are required to submit, 
no later than the Federal due date for receipt of the application, the 
following information to the head of the appropriate state and local 
health agencies in the area(s) to be impacted: (a) a copy of the face 
page of the applications (SF 424), (b) a summary of the project 
(PHSIS), not to exceed one page, which provides: (1) a description of 
the population to be served, (2) a summary of the services to be 
provided,

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(3) a description of the coordination planned with the appropriate 
State or local health agencies. Copies of the letters forwarding the 
PHSIS to these authorities must be contained in the application 
materials submitted to the Office of Minority Health.

State Reviews

    This program is subject to the requirements of EO 12372. Executive 
Order 12372 allows States the option of setting up a system for 
reviewing applications from within their States for assistance under 
certain Federal programs. The application kit to be made available 
under this notice will contain a listing of States which have chosen to 
set up a review system and will include a State Single Point of Contact 
(SPOC) in the State for review. Applications (other than federally 
recognized Indian tribes) should contact their SPOCs as early as 
possible to alert them to the prospective applications and receive any 
necessary instructions on the State process. For proposed projects 
serving more than one State, the applicant is advised to contact the 
SPOC of each affected State. The due date for State process 
recommendations is 60 days after the application deadline by the Office 
of Minority Health's Grants Management Officer. The Office of Minority 
Health does not guarantee that it will accommodate or explain its 
responses to State process recommendations received after that date. 
(See ``Intergovernmental Review of Federal Programs,'' Executive Order 
12372, and 45 CFR Part 100 for a description of the review process and 
requirements.)

OMB Catalog of Federal Domestic Assistance

    The OMB Catalog of Federal Domestic Assistance Number for the 
Bilingual and Bicultural Service Demonstration Program is 93.105.

    Dated: January 23, 1997.
Clay E. Simpson, Jr.,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 97-3522 Filed 2-11-97; 8:45 am]
BILLING CODE 4160-17-M